Anesthesia Coding Alert

Don't miss extra reimbursement if you meet criteria

Focusing your energy on coding TEE probe placements - and ignoring those small additional services such as Doppler flow studies - is a quick way to topple your TEE payments.

Some anesthesia coders might never see cases involving TEE and Doppler, but others might. This can be especially true for coders who deal with a lot of cardiac anesthesia cases.

Physicians often use an echocardiogram to create a picture of the patient's cardiac structures; it shows basic anatomy such as heart muscle and valve leaflets. But when the physician needs more detailed information about the patient's heart, he may rely on a Doppler exam (sometimes called a Doppler flow study) and other monitoring techniques instead for more valuable information. Don't Report Doppler Solo When the anesthesiologist opts to use Doppler in conjunction with TEE, CPT lists several codes that could apply to the study. These include:

+CPT 93320 - Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); complete

+CPT 93321 - ... follow-up or limited study (List separately in addition to codes for echocardiographic imaging)

+CPT 93325 - Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography). Pair it with echo: The anesthesiologist must use Doppler in conjunction with echocardiography, so you'll also report the appropriate echocardiography code. (You know this because the descriptors instruct you to report 93320-93325 in addition to the echocardiography codes). CPT includes several echocardiography codes (93303-93350), but the ones most commonly used to report the base service are:   CPT 93307 - Echocardiography, transthoracic, real-time  with image documentation (2D) with or without M-mode recording; complete
  CPT 93308 - ... follow-up or limited study
  +CPT 93325 - Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography). "In cardiac cases, virtually only color Doppler is used to indicate the flow and direction," Scott Groudine, MD, an Albany, NY anesthesiologist, says. "Where the blood is flowing and in what direction is very important in heart valve replacement operations. Spectral Doppler (black and white) is rarely used in the OR for these cases."

Caution: Although you code the procedure, you probably won't report the contrast agent. In most instances, the hospital bills for the contrast material. Whittle TEE Codes Down to 4 Probabilities Because the Doppler study is separate from the TEE probe placement, you can bill for both procedures. CPT includes a range of codes related to TEE, but the ones anesthesiologists use most often are:   93312 - Echocardiography, transesophageal, real  time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report. Some [...]