Anesthesia Coding Alert

Question: I was asked today about TEE coding by someone who stated that there is different coding depending on whether the provider is certified or not. I’ve never heard of this. I’m in Ohio and the billing company is in another state. Can you help me?

Ohio Subscriber

Answer: The first thing you need to know is that TEE (transesophageal echocardiography) coding is dependent on the service the anesthesiologist provides.

For example, did he or she simply insert the probe for monitoring, or did he or she perform a diagnostic TEE that will help diagnose problems when done in conjunction with a heart surgery?

For placement only, you would report 93313 (Echocardiography, transesophageal, realtime with image documentation [2D] [with or without M-mode recording]; placement of transesophageal probe only).

For the diagnostic TEE used with another procedure, you would submit 93312 (…  including probe placement, image acquisition, interpretation and report) instead. If the anesthesiologist performs a diagnostic TEE, there must be a separate diagnostic report dictated with the findings before you can try to bill separately.

Very important: If the anesthesiologist did a diagnostic TEE, he is required to be specially “trained” on the technique before you can bill it. Not every anesthesiologist can perform a diagnostic TEE. That means you need to know whether your anesthesiologist is specifically trained in TEEs before you report them.

One more note: Medicare bundles a monitoring TEE, so don’t expect separate payment for either 93318 (Echocardiography, transesophageal [TEE] for monitoring purposes, including probe placement, real time 2dimensional image acquisition and interpretation leading to ongoing [continuous] assessment of [dynamically changing] cardiac pumping function and to therapeutic measures on an immediate time basis) or 93355 (Echocardiography, transesophageal [TEE] for guidance of a transcatheter intracardiac or great vessel[s] structural intervention[s] [e.g., TAVR, transcatheter pulmonary valve replacement, mitral valve repair, paravalvular regurgitation repair, left atrial appendage occlusion/closure, ventricular septal defect closure] [peri-and intraprocedural], realtime image acquisition and documentation, guidance with quantitative measurements, probe manipulation, interpretation, and report, including diagnostic transesophageal echocardiography and, when performed, administration of ultrasound contrast, Doppler, color flow, and 3D). Some insurers follow Medicare’s stance, but others might not.