Anesthesia Coding Alert

Hint: You need to include these detailed diagnosis codes

The next time you find yourself coding for a cardiac case in which the anesthesiologist used a Doppler exam in addition to TEE don't panic - turn to your diagnoses for guidance.

Before you bill for Doppler in conjunction with TEE, be sure the patient's diagnosis warrants TEE, advises Judy Wilson, CPC, CMC, CCP, CRS, business administrator for Anesthesia Specialists in Virginia Beach, Va. She says carriers often don't pay for 414.8 (Other specified forms of chronic ischemic heart disease), so don't submit that as your only diagnosis supporting Doppler with TEE.

"Many carriers have policies that list the codes they will pay when it comes to color Doppler," Albany, NY anesthesiologist Scott Groudine, MD, points out. Carriers often prefer more detailed diagnoses for TEE, such as:

429.3 - Cardiomegaly
429.71 - Acquired cardiac septal defect
394.0 - Mitral stenosis
440.0 - Atherosclerosis; of aorta
427.31- Atrial fibrillation
V15.1- Other personal history presenting hazards to health; surgery to heart and great vessels. How do you get your physicians to better document all of the patient's diagnoses in hopes that one will justify TEE?

Wilson makes it easy for her physicians by providing them with a TEE Billing Form with check boxes for each coding component: procedure code, applicable add-on codes, and ICD-9 diagnoses grouped by category.

Caution: Don't push your physicians toward only reporting these diagnoses because the carrier will pay for them; always report the most accurate code, whatever the reimbursement might be.

Having this sheet is a win/win for the group. It helps physicians document all aspects of the procedure, which makes coding simpler and more accurate.