Anesthesia Coding Alert

Anesthesiologists primarily use TEE for monitoring purposes, so the code from the above list that many coders rely on is 93318. Caution: Remember that Medicare does not pay TEE for monitoring, says Scott Groudine, MD, an Albany, N.Y., anesthesiologist.

Verify Your Doctor's Certification

Before an anesthesiologist can perform TEE placement - for any type of case - he must complete training and be certified through the SCA (Society of Cardiovascular Anesthesiologists), says Darlene Ogbugadu, CPC, billing supervisor for the department of anesthesiology at Northwestern Medical Faculty Foundation in Chicago.

The American Society of Anesthesiologists (ASA) and SCA House of Delegates approved and published guidelines for TEE in 1996 that addressed more anesthesia-related issues. These included indications for the procedure, education requirements, training documentation, technical aspects of performing TEE, the use of TEE, and bundling issues when reporting the procedure.

Info: Guidelines for performing TEE continue to become stricter. Log on to the ASA's Web site (www.asahq.org) to see the House of Delegate's complete statement on TEE, or SCA's Web site (www.scahq.org) to see the task force guidelines for TEE.

Watch for Other Cases Using TEE

Several factors indicate that a patient is a good candidate for TEE, even if he is not scheduled for a cardiac procedure. The decision is based on the physician's diagnosis of what's causing the patient's hemodynamic disturbances. The patient's preoperative history and physical assessment (including information about congenital or cardiovascular diseases) are a better indication of TEE than the procedure itself.
 
Martin Dauber, MD, director of neuroanesthesia and assistant professor of anesthesia at Northwestern Medical Faculty Foundation in Chicago, shares a few examples of noncardiac TEE cases:  

What makes these procedures good candidates for TEE instead of another monitoring technique? Because of the information TEE provides, Ogbugadu says. "The TEE provides information that no other diagnostic procedure can provide related to surgical interventions, anesthesia effects, and changing patient conditions," she says.

Example: An electrocardiogram (ECG) and Swan-Ganz catheter can both provide continuous assessment of the patient's cardiac performance. TEE can give the anesthesiologist more specific diagnostic information - and can do it more quickly than the ECG or Swan-Ganz.

Report the Case Correctly 

Because TEE is not a standard intraoperative technique and because it is used to benefit the patient's care, you can report it separately from the anesthesia service. However, Ogbugadu advises that you be sure to have documentation supporting its use before billing.

"The TEE procedure is rendered in addition to the anesthesia service provided," she says. "You should only bill for TEE if the surgeon requests the service or if the anesthesiologist believes the TEE is clinically beneficial to the patient."

"TEE is a very useful monitor and can be used as such if you don't need to be paid for it," Groudine adds. "If you want to bill for the service, it must be medically justified as a diagnostic or therapeutic intervention so the 93312-93314 codes apply."

When you do report TEE for a noncardiac case, code it with 93313 and append modifier -59 (Distinct procedural service) because it's in addition to the anesthesia service you'll report. In noncardiac TEE cases, Ogbugadu also recommends submitting the operative report and anesthesia documentation that supports the medical necessity for TEE.
 
Many providers expect the trend of noncardiac TEE cases to continue because of its diagnostic advantage and its importance as a resident training tool. Whatever the reason, documentation of your physician's training and the patient's need for TEE will help move your claims through the reimbursement process.