Reader Question:
Remember 59 for Medicare TEE
Published on Wed Oct 10, 2007
Question: Does Medicare have certain payment criteria for transesophageal echocardiography (TEE)? Illinois Subscriber Answer: Yes. Medicare -- and many other carriers -- reimburses an anesthesiologist for TEE service only if the procedure is diagnostic. That means your physician must generate a separate, diagnostic TEE interpretation and report, plus the anesthesia record. Modify it: To show that the TEE is a separate diagnostic service, Medicare requires modifier 59 (Distinct procedural service) along with the procedure code (usually 93312, Echocardiography, transesophageal, real time with image documentation [2D] [with or without M-mode recording]; including probe placement, image acquisition, interpretation and report). You should also have a separate diagnosis to justify medical necessity for TEE, such as a mitral valve disease (394.x). Follow guides: Most carriers have TEE coding and coverage guidelines, so check your payers' policies. Visit your local carrier's Web site or the CMS Web site to find the local coverage determinations (LCDs) that apply to your group.
