Anesthesia Coding Alert

Question: Is there any way Medicare will pay for TEE (transesophageal echocardiography) now that the July NCCI edits bundled it with so many procedures? I have a letter from Medicare to the ASA stating that they'll pay, but they keep denying claims.

Missouri Subscriber
 
Answer: Part of the confusion may stem from two different stances on this issue in NCCI edits for 2003. The edits effective April 1 (NCCI 9.1) changed the status indicators for most TEE procedures and kept anesthesiologists from appending modifier -59 (Distinct procedural service) to get reimbursed for their involvement.
 
The next round of NCCI edit (CCI 9.2, effective July 1) reinstated modifier indicator "1" to four TEE codes so anesthesiologists can get paid for diagnostic or therapeutic TEEs (however, TEEs used for monitoring are considered bundled with the other monitoring functions of the global anesthesia fee). These codes are 93312 (Echocardiography, transesophageal, real time with image documentation [2D] [with or without M-mode recording]; including probe placement, image acquisition, interpretation and report), 93313 (... placement of transesophageal probe only), 93315 (Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report) and 93316 (... placement of transesophageal probe only).
 
Some local medical review policies limit the types of diagnoses your Medicare carrier reimburses for TEE, so check your local guidelines. Once you're sure the diagnosis is acceptable and the TEE was for diagnosis or treatment, resubmit the claim with modifier -59.