Cardiology Coding Alert
Transesophageal Monitoring
Iowa Subscriber
Answer: The answer to this question is complicated. Typically, the cardiologist would obtain pre- and postprocedure transesophageal (TEE) images, and the anesthesiologist would monitor the TEE continuously.
If the cardiologist monitored the TEE continuously, 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) could be reported. In such cases, there is no reason +93320 (Doppler echocardiography, pulsed wave and/or continuous wave with spectral display [list separately in addition to codes for echocardiographic imaging]; complete) and +93325 (Doppler echocardiography color flow velocity mapping [list separately in addition to codes for echocardiography]) could not be billed in addition to 93318.
If the cardiologist does not monitor the TEE continuously, 93318 should not be billed. Instead, the cardiologist should bill twice for 93314 (Echocardiography, transesophageal, real time with image documentation [2D] [with or without M-mode recording]; image acquisition, interpretation and report only) to cover the pre-op and the post-op interps.
Both +93320 and +93325 are payable when reported as add-on codes to 93314.
It may be more difficult to obtain payment on first submission when these codes are submitted with 93318 because this code is reported more by anesthesiologists than cardiologists. As a result, carriers may not realize why Doppler and color flow codes are also included in the charge.
You Be the Coder and Reader Questions were answered by Sandy Fuller, CPC, a cardiology coding and reimbursement specialist in Abilene, Texas; Belinda Inabinet, CPC, technical support manager who heads a coding team at South Carolina Heart Center, a 21-physician practice in Columbia, S.C.; Linda Laghab, CPC, coding manager for Pediatric Management Group at Childrens Hospital Los Angeles; Tamara Shy, RHIA, a cardiology coding data specialist at William Beaumont Hospital in Royal Oak, Mich.; Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan.; and Marko Yakovlevitch, MD, FACP, FACC, a cardiologist in private practice in Seattle.
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