Anesthesia Coding Alert

Remember one service you can't report with PA catheters.

If your anesthesiologist participates in a cardiac surgery case, chances are he uses a pulmonary artery (or PA) catheter during the procedure. PA catheters make the list of monitoring devices you can often code separately from other services, so keep these two tips in mind for successful claims.

Zero In On the Correct Code

Your physician can choose between several types of PA catheters. Some PA catheters allow the anesthesiologist to temporarily pace the heart, which might be necessary for patients with underlying cardiac rhythm disturbances. You might report diagnoses such as 426. x (Conduction disorders), 427.x (Cardiac dysrhythmias), or 428.x (Heart failure) in that situation. Others allow the physician to continually monitor cardiac output and/or monitor mixed venous oxygen saturation.

Coding key: No matter which PA catheter the anesthesiologist chooses, he places them all the same way and CPT covers all types with a single code. Report any PA catheter insertion with 93503 (Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes).

Steer Clear of Extra TEE Coding

Anesthesiologists also use transesophageal echocardiography (or TEE) to help maximize a patient's cardiac function and optimize fluid status. Your physician might use a PA catheter and TEE during a single case, but don't automatically assume you'll be paid for both lines.

Whether a payer reimburses for TEE depends partly on the TEE's purpose and your specific payers. Remember that an intraoperative TEE isn't the same as at TEE for monitoring purposes, says Christina Neighbors, MA, CPC, CCC, ACS-CA, charge capture reconciliation specialist and coder with St. Joseph Heart and Vascular Center in  Tacoma, Wash. Ask yourself whether the anesthesiologist used TEE for additional monitoring during the case, or whether he completed a diagnostic or therapeutic TEE and understand your payer The American Society of Anesthesiologists (ASA) considers TEE "an additional service that is not part of the usual anesthetic work," as indications for the service is based on a patient's individual condition. However, Medicare doesn't agree.

No-go: Medicare won't pay for TEE services used only for monitoring. Medicare considers monitoring as part of the global anesthesia fee, and some other payers agree. According to the Correct Coding Initiative (CCI), you cannot bill monitoring services using any modifier. Keep your claim compliant, however, by reporting the service with 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).

Possible pay: Insurance companies vary on whether they will pay for monitoring, diagnostic TEE usage. Some payers might require your physician to be credentialed to provide these services. Report the appropriate codes from 93312-93314 (Echocardiography, transesophageal, real time with image documentation [2D] [with or without M-mode recording] ...) or 93315-93317 (Transesophageal echocardiography for congenital cardiac anomalies ...) for diagnostic services.

Before submitting a claim for TEE, remember this final tip from Judy Wilson, CPC, CPC-H, CPC-P, CPC-I, CANPC, CMBSI, SMRS, business administrator for Anesthesia Specialists, PTR, in Virginia Beach. "Your anesthesiologist must perform the placement, image, acquisition, and interpretation (including a written report) to correctly bill," she says.