# TEE Coding Question



## zona6789@yahoo.com (Nov 25, 2013)

we are doing the procedure TEE.

the following is what i get from my anesthesiologists


TEE
Case type: CABG.

Procedure:TEE
Patient location during procedure: OR
Echo Evaluations: M/2D/Doppler/Color
Anesthesiologist: XXX
Atria:  

Left Atrium Findings: mildly enlarged
Right Atrium Findings: mildly enlarged
LA Masses: none
Right Atrium Masses: lypomatous septum.
IAS: lipomatous hypertrophy


Ventricles:


Left Ventricle:    mild LVH   normal
LV Segmental WM: 
Inferior Wall: mild HK
Inferolateral Wall:normal
Lateral Wall:normal
Anterior Wall: normal
Anteroseptum: normal
Septum: normal
Cardiac Output:
LV Diastolic Function:
Mitral Inflow:
Pulmonary Venous Flow:
Tissue Doppler:
Septal E' Velocity: 8 cm/s  Lateral E' Velocity: 10 cm/sRight Ventricle:
RV Function: normal
Aortic Valve:

Aortic Valve: normal
Regurgitation:Regurgitation: none
Mitral Valve:

Morphology: normal
Tricuspid Valve:

Morphology: normal
Pulmonic Valve:  

Morphology: normal
Stenosis:


Great Vessels:  

Atherosclerosis of Ascending Aorta:Grade 2
Other:  

Pericardium: normal

what code should i use on this when it comes over?  

99312 or 99313 and why?  if you dont mind telling me your reasoning.

is the above sufficient for interpretation and report is what I am asking.

thank you!

judith


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## jmote14 (Nov 25, 2013)

Did you transpose your numbers?

A TEE is

93312
93320
93325

My reasoning is nothing more than because that's what my coding book says.


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## Michele Hannon (Nov 25, 2013)

Keep in mind, CMS will not pay for TEE employed for "monitoring" purposes(CPT 99318). It must be for "diagnostic" purposes(CPT 99312-99317). Many Medicare Carriers have specific LCD's on TEE services.

One of the most important aspects of perioperative TEE is the Post-Cardiopulmonary Bypass study (CPB): after all, CABG or valvular surgery is performed for "corrective" reasons.

The purpose of the study is to identify the outcomes of the surgery and to identify cardiac function. It should concentrate on those areas that may have changed or where no change is an important finding.

When was the study performed; post CPB, following protamine, before or after chest closure? The findings at these times may be markedly different so it is important to note when the study was recorded.
There should be some note of LV function and any concurrent supportive treatment: inotropic infusions or mechanical support devices used. In patients undergoing revascularization (CABG) attention should be directed to, and a note made of significant regional wall motion abnormality in the relevant areas.
In valve replacement surgery the prosthetic valve function should be noted. In valve repair, the severity and nature of any residual regurgitation should be noted.

There must also be an archived recording.


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