Anesthesia Coding Alert

Beginning July 1, Medicare will again reimburse anesthesiologists' services for some transesophageal echocardiography (TEE) procedures performed during an anesthetic. The caveat is that it must be a diagnostic TEE procedure conducted with an anesthetic. Most TEE procedures are diagnostic, used to establish myocardial ischemia or cardiac valve function.

This change modifies the National Correct Coding Initiative (NCCI) edits implemented April 1. Those edits (NCCI Edits 9.1) changed the status indicators for most TEE procedure codes and kept anesthesiologists from appending modifier -59 (Distinct procedural service) to receive payment for services. Four TEE codes will be reinstated with modifier indicator "1" status, which means anesthesiologists can again report their services with modifier -59:

When NCCI 9.1 bundled the TEE services with anesthesia, the American Society of Anesthesiologists (ASA) began working to have this changed so anesthesiologists could continue billing for their involvement in the procedure.

According to a response letter from CMS to the ASA, "CMS will modify these edits [from NCCI 9.1] to allow use of NCCI associated modifiers if the TEE procedure is for diagnostic purposes. As you know, in the past CMS has allowed providers to report 'image acquisition, interpretation and report only' (CPT codes 93314, Echocardiography, transesophageal, real time with image documentation [2D] [with or without M-mode recording]; image acquisition, interpretation and report only, and 93317, Transesophageal echocardiography for congenital cardiac anomalies; image acquisition, interpretation and report only) when performed for diagnostic purposes during anesthesia. CMS has decided to also allow providers to bill for the probe placement when a diagnostic TEE is performed during anesthesia. CMS realizes that when a provider inserts the TEE probe the provider does not know whether it will be utilized solely for monitoring or also for a diagnostic TEE. If the TEE probe is used solely for monitoring, its placement is not separately reportable. However, if the patient requires a diagnostic TEE by the anesthesiologist, both the placement of the probe and the interpretation may be reported."

The letter also reminds providers that codes 93312-93317 should not be reported for TEE for monitoring purposes during anesthesia. TEE used for monitoring is bundled with the anesthesia service and is not separately billable, as with most monitoring services.

"Medicare's again allowing modifier -59 with these codes will make it easier for anesthesia departments to provide intraoperative diagnostic TEE to all patients who need this service," says Karin Bierstein, JD,  MPH, assistant director of ASA's Office of Governmental Affairs (Regulatory). "The original edit would have barred full reimbursement unless a second anesthesiologist came to perform the TEE, and few departments have anesthesiologists to spare."
 

The changes will be retroactive to April 1, 2003, when the TEE reporting was first disallowed. Providers who performed diagnostic TEE procedures may resubmit claims and supporting documentation to their local carriers for adjustment after July 1.