Cardiology Coding Alert

Question: Medicare has been denying claims that include 93312, +93320-26, and +93325-26. Should I be reporting TEEs differently?

Nebraska Subscriber

Answer: First, be sure that you append modifier 26 (Professional component) to 93312 (Echocardiography, transesophageal, real time with image documentation [2D] [with or without M-mode recording]; including probe placement, image acquisition, interpretation and report) when the cardiologist performs a hospital transesophageal echocardiography (TEE).

Modifiers: Your question indicates that you already are appending modifier 26 to +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]).

Code 93312 has professional and technical components just as +93320 and +93325 do, so you need to indicate that you are reporting only the professional component of each code, if that is the case.

Place of service: Second, check your place of service. Cardiologists often perform these procedures in the inpatient setting. If so, be sure that your place of service is listed as "21," which stands for inpatient hospital setting. Your payer may have edits set up to deny any TEEs performed in the outpatient setting (place of service "22").