Anesthesia Coding Alert

Question: Our physician often uses TEE (trans-esophageal echocardiography) during cardiac anesthesia cases. The guidelines for reporting TEE seem to have shifted during the past few years. What are the latest guidelines?

Alabama Subscriber

Answer: If your physician uses TEE for diagnostic or therapeutic purposes, you can code separately for the service -- with one exception. If your anesthesiologist uses TEE for monitoring purposes, you cannot report 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) in addition to the procedure's anesthesia code because the global anesthesia fee includes monitoring.
 
CPT includes six other codes for TEE services: 93312-93314, Echocardiography, transesophageal,  real-time image with documentation (2D) (with or without M-mode recording); and 93315-93317, Transesophageal echocardiography for congenital cardiac anomalies.
 
If your anesthesiologist is credentialed to perform these TEE services and you have sufficient documentation to support his work, you can code them in addition to the procedural anesthesia.