Anesthesia Coding Alert

Hint: Specific diagnoses and extra services can make a difference  Anesthesiologists often use transesophageal echocardiography (TEE) during cardiovascular cases, but they don't always understand which parts of the service carriers reimburse -- or what documentation you need to correctly code the case. If your physicians fall into these categories, use these expert tips to get their documentation -- and your coding -- back on track. Know Which Codes Apply to Your Physicians     CPT includes several codes for TEE, but some usually apply to cardiologists rather than anesthesiologists. The complete group of TEE codes includes:

• 93312 -- Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report. Some anesthesiologists have credentials to perform the entire TEE procedure, interpretation and report.

• 93313 -- ... placement of transesophageal probe only. This code does not include the TEE interpretation and report. Submit it when your anesthesiologist places the probe but a cardiologist performs the interpretation and report.

• 93314 -- ... image acquisition, interpretation and report only. This code coincides with 93313: If the anesthesiologist reports 93313, the cardiologist must report 93314.

• 93315 -- Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report. You might be able to report this code if your anesthesiologist is credentialed to perform the entire TEE procedure (especially if he concentrates on cardiac anesthesia).

• 93316 -- ... placement of transesophageal probe only

• 93317 -- ... image acquisition, interpretation and report only. Codes 93316 and 93317 are the same extended descriptors as 93313 and 93314. You'll choose the correct code based on whether the patient has congenital heart problems.

• 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. Many anesthesiologists report this code most often because they use TEE probes for monitoring. Heads up: Most carriers do not pay for 93318 because the global anesthesia fee includes monitoring. You can report 93318 for accuracy's sake, but don't expect it to add much to your bottom line. Modifier note: Because you can report TEE services in addition to the procedural anesthesia, append modifier 59 (Distinct procedural service) to the TEE code if this is the case. And be sure to include a separate diagnosis for Medicare.

"We also add modifier 26 (Professional component)," says Judy A. Wilson, CPC, CPC-P, CCP, CMC, CMBS, business administrator for Anesthesia Specialists in Virginia Beach, Va. Reporting modifier 26 shows that your physician completed the test but does not own the equipment. Whoever owns the equipment (usually the hospital) bills the same TEE code with modifier (Technical [...]