Wiki Charge for intracopertive TEE during AVR (for facility)

[Chlrtrep]

Charge for intraoperative TEE during AVR (for facility)

Question regarding Intraoperative TEE for facility during open AVR surgery. I am not familiar with the non invasive cardiology side for facility coding. However the cardiology dept is asking if they are able to charge/code for their staff going to the OR to perform a TEE during AVR surgery. It is my understanding that they do this for almost every AVR procedure. Additionally in some cases the patient has had a TEE/TTE prior to surgery however sometimes if has been a month. Therefore the surgeon will request a TEE while patient is in the surgical room one before surgery and also one during the surgery after the valve has been implanted. Although this is inpatient the Cardiology dept would still like to code for services performed 93312 I can not find information regarding if this is acceptable. And the LCD has been currently retired. Any thoughts would be appreciated.

sample op report

NAME OF PROCEDURE
1. Aortic valve replacement (25 mm St. Jude Trifecta tissue valve).
2. Placement of right heart catheter.
3. Placement of radial arterial line.
4. Placement of femoral arterial line.
5. Intraoperative transesophageal echocardiography.

Right heart catheter was placed utilizing
sterile Seldinger technique. Intraoperative TEE was performed which
revealed stenotic aortic valve leaflets with mild aortic insufficiency,
no significant mitral regurgitation and mildly diminished ventricular
function.
Repeat TEE revealed
satisfactory function of the aortic valve leaflets, no significant
aortic insufficiency or perivalvular leak. After adequate de-airing was
confirmed by TEE, the patient was weaned from bypass and decannulated.

 

[Misty Dawn]

Question regarding Intraoperative TEE for facility during open AVR surgery. I am not familiar with the non invasive cardiology side for facility coding. However the cardiology dept is asking if they are able to charge/code for their staff going to the OR to perform a TEE during AVR surgery. It is my understanding that they do this for almost every AVR procedure. Additionally in some cases the patient has had a TEE/TTE prior to surgery however sometimes if has been a month. Therefore the surgeon will request a TEE while patient is in the surgical room one before surgery and also one during the surgery after the valve has been implanted. Although this is inpatient the Cardiology dept would still like to code for services performed 93312 I can not find information regarding if this is acceptable. And the LCD has been currently retired. Any thoughts would be appreciated.

sample op report

NAME OF PROCEDURE
1. Aortic valve replacement (25 mm St. Jude Trifecta tissue valve).
2. Placement of right heart catheter.
3. Placement of radial arterial line.
4. Placement of femoral arterial line.
5. Intraoperative transesophageal echocardiography.

Right heart catheter was placed utilizing
sterile Seldinger technique. Intraoperative TEE was performed which
revealed stenotic aortic valve leaflets with mild aortic insufficiency,
no significant mitral regurgitation and mildly diminished ventricular
function.
Repeat TEE revealed
satisfactory function of the aortic valve leaflets, no significant
aortic insufficiency or perivalvular leak. After adequate de-airing was
confirmed by TEE, the patient was weaned from bypass and decannulated.

Look at CPT 93355 for inter-operative TEE during Valve surgery. There are some special guidelines on who can use the code.

HTH,

Misty Sebert CPC, CCC, CCVTC

 

[Chlrtrep]

Look at CPT 93355 for inter-operative TEE during Valve surgery. There are some special guidelines on who can use the code.

HTH,

Misty Sebert CPC, CCC, CCVTC

Misty,


I may not have mentioned this but this is for open surgical valve replacements not Intra-catheter valve procedures. It is my understanding that 93355 is transcatheter valve procedures.

 

[Misty Dawn]

Sorry Chlrtrep!! you did say "open" right in the first line and I blew right over it! For open procedures when they do TEE before/during/and,or after I use CPT 93318. CPT 93318 is for TEE monitoring to asses function assist with decisions performed intraoperatively (eg, open cardiac procedures). Coded one time per surgery.

Thanks,

Misty Sebert CPC, CCC, CCVTC