Anesthesia Coding Alert

Anesthesiologists who are certified to place probes or perform other services related to transesophageal echocardiography (TEE) will no longer be paid separately for these services, according to NCCI Edits 9.1.

TEE procedures (93312-93318) have been considered components of anesthesia procedures for some time, but anesthesiologists could unbundle some of the services with modifier -59 (Distinct procedural service) and get paid for their involvement in the procedure. All TEE codes except 93318 (Echocardiography, transesophageal [TEE] for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing [continuous] assessment of [dynamically changing] cardiac pumping function and to therapeutic measures on an immediate time basis) were eligible for unbundling (when appropriate), according to their modifier status indicators of "1" in NCCI edits for 2002.

NCCI 9.1, effective April 1, changes that by assigning a "0" modifier indicator to the TEE codes, meaning the edit is absolute and you cannot override it with a modifier. The TEE codes affected by the edits are: CPT 93312 Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report
CPT 93313 ... placement of transesophageal probe only
CPT 93315 Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report
93316 ... placement of transesophageal probe only. The exception to these edits is 93314 (Echocardio-graphy, transesophageal, real time with image documentation [2D] [with or without M-mode recording]; image acquisition, interpretation and report only), which anesthesiologists can still bill separately by appending modifier -59. The American Society of Anesthesiologists is working to unbundle the affected TEE codes from anesthesia services so physicians can continue billing for their involvement in the procedure.