Anesthesia Coding Alert

Question: Our physician provided anesthesia during a triple bypass vein graft (off pump). The anesthesiologist placed an arterial line and a Swan-Ganz catheter preoperatively and used intraoperative transesophageal (TEE) monitoring. He also monitored and interpreted blood gases intraoperatively. How should I code this case?


New Jersey Subscriber

  
Answer: Begin with 00566 (Anesthesia for direct coronary artery bypass grafting without pump oxygenator) for the surgical anesthesia.

Report 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous) for the arterial line and 93503 (Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes) for the Swan-Ganz catheter. The anesthesia service includes blood gas monitoring, so don't report it separately.

TEE reimbursement depends on why your physician used it and your local policies. You can bill for TEE when the physician uses it for diagnostic purposes and generates a separate report. Many states do not allow separate billing when the physician uses TEE only for monitoring, although CPT includes a code for the service (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).

Your state (New Jersey) appears to allow nonroutine intraoperative TEE for diagnostic purposes but does not pay an anesthesiologist for TEE during monitoring. Your physician should keep a complete record by documenting that he used TEE for monitoring, but you can't code for the service.