"Billing for transesophageal echocardiography (TEE) is one of the gray areas of anesthesia reimbursement. Many Medicare carriers have local reimbursement policies regarding the procedure, but most do not specifically state how it relates to anesthesia. TEEs require special training and certification, so the correct code depends on who performs which part of the procedure. It also is important to know your local regulations before seeking TEE reimbursement.
What Is TEE?
TEE is an invasive procedure that involves placing a transducer on the tip of an endoscope. The scope is inserted into the patients esophagus to record a two-dimensional echocardiograph. Its considered standard care during certain procedures on adults or children. These can include the diagnosis of myocardial ischemia (414.8), confirmation that valve reconstruction and other surgical repairs are successful, or to provide diagnostic information that could not be gotten preoperatively by a less invasive method. One advantage that TEE has over other monitoring procedures such as transthoracic echocardiography (TTE) is that it may be left in place and used throughout a surgical procedure to detect problems and continually monitor key parameters instead of being used intermittently.
A half-dozen codes in CPT Codes 2000 apply to TEE. The two primary codes 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) and 93315 (transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report). Related codes for the procedure are 93313 (echocardiography, transesophageal, real time with image documentation [2D] [with or without M-mode recording]; placement of transesophageal probe only), 93314 (echocardiography, transesophageal, real time with image documentation [2D] [with or without M-mode recording]; image acquisition, interpretation and report only), 93316 (transesophageal echocardiography for congenital cardiac anomalies; placement of transesophageal probe only) and 93317 (transesophageal echocardiography for congenital cardiac anomalies; image acquisition, interpretation and report only).
Correct Code Depends on Training
This procedure requires special training and certification, so most facilities have a technician on staff to perform diagnostic TEEs. Cindie Capito, physician anesthesia coder for the practice group Southern Tier Anesthesiologists PC, in Olean, N.Y., offers these examples of how the procedure should be coded, depending on who performs it and what level of service is provided.
1. An anesthesiologist places the probe, and a cardiologist interprets the report: The anesthesiologist bills with 93313-26 (placement of transesophageal probe only; professional component), and the cardiac surgeon bills 93314-26 (image acquisition, interpretation and report only; professional component). This is how many TEEs are performed, provided the hospital or other place of service owns the equipment.
