Wiki Tee help

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indanesthesia

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OK, so we have been doing TEE's for a few months now and I still have not got the hang of billing for these, im not sure why it is so hard to figure out. We have gotten paid for 50% of them, but they have all denied originally and i have to appeal them. I want to get where we just bill and get paid. Ok.....the dr is turning them in for 93312. He only does them on CABG procedures, so i bill them with 93312 with 26 modifier. Now the problem im having is that insurance is saying they want time units....So how do we get around that? I entered the code into our system (medical manager) and it looks to be used as a timed procedure, but the time i use on the CABG. And the charge comes out to $455 when i entered the base units. Im not sure if this is correct. And how much do you charge for 93325 (color flow doppler)?
Please help, the drs are on my case until i get this corrected and this is the only code ive ever had a problem getting paid in all my years
 
93312 states "including... interpretation and report" so why would you use mod-26 when the CPT directs that mod-26 only be used "When interpretation is performed separately."? Maybe that is why it is being denied or asked for minutes. Just a thought.
 
In order to bill 93312/26 to Medicare, the physician must have the required certification (at least in our region--check yours). There should be a full report and it should be for diagnostic not monitoring. Make sure the diagnosis matches. 414.00 usually won't fly. Is there aortic stenosis on the TEE report or another diagnosis that would be appropriate. Also, if it is not diagnostic and simply for monitoring Medicare does not pay for it and you would code 93318--other carriers may pay for that. Hope this helps. The ASA Relative Value Guide has information on billing for TEE listed in that little book. If the physician performs a TEE at a facility the 26 modifier is required. Some payers may also want a 59 modifier per reports from other coders, though I don't have any payers requesting that.
 
I work for a Anesthesia Group and we also do Tee for CABG and we code and bill our Tee 93312 2659. We are getting paid.

Kimberly CPC
 
Indanesthesia,

We also bill diagnostic TEE services.
It appears your billing program is trying to bill this service as anesthesia versus a diagnostic service. First, you may need to add the CPT code to your fee schedule as a flat fee service -or- change type of service (from anesthesia or 7) so that your system does not attempt to bill time for this service. Also, the -26 modifier is necessary to indicate professional component (meaning you don't OWN the echo equipment) and the facility will bill for the technical component (TC) and also, if appropriate, add the -59 modifier because 93312 is bundled into every anesthesia code but has a "1" qualifier (modifier allowed) meaning the bundle can be over-ridden with -59 modifier.

Julie D, CPC
 
We do TEE's also but only do the placement (93313). Does anybody know what type of documentation has to be with the records to bill for this?

Thanks!
 
Thank you all so much for the help.
@ JDrueppel....on the flat fee service...what is the going rate to charge for 93312, 93325,
 
Indanesthesia,

Sorry I missed your follow up question. I'm not comfortable discussing fees as it could be considered price fixing. I suggest you look at the RVUs for the codes in questions and set your fee accordingly.

Julie D, CPC
 
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