Check Ultrasound Diagnostics for Transesophageal Doppler Coverage

Use new Health Care Procedure Coding System (HCPCS) Level II code G9157 Transesophageal Doppler used for cardiac monitoring to bill for esophageal Doppler monitoring, effective Oct. 1. Medicare will allow G9157 to be billed with either modifier 26 Professional component or modifier TC Technical component when services are provided in an ambulatory surgical center (ASC), place of service (POS) 24, for operative patients with a need for intra-operative fluid optimization.

Also effective Oct. 1, Medicare contractors will deny:

  • claims lines containing CPT® code 76999 Unlisted ultrasound procedure (eg, diagnostic, interventional) when billing for esophageal Doppler monitoring.
  • code G9157 when billed with modifier TC for services provided in an inpatient hospital (POS 21) using claim adjustment reason code (CARC) 125 Submission/billing error(s), remittance advice remark code (RARC) M2 Not paid separately when the patient is an inpatient, and group code CO Contractual obligation.
  • code G9157 when billed in any POS other than 21 or 24 using CARC 58 Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service and group code CO.

For more information, read transmittal R2472CP and MLN Matters® article MM7819 on CMS’ website.

Source: MLN Matters® article MM7819

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One Response to “Check Ultrasound Diagnostics for Transesophageal Doppler Coverage”

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