Anesthesia: Getting Paid All You’re Entitled?

by:  Judy A. Wilson, CPC, CPC-H, CPC-P, CPC-I, CANPC, CMBSI, CMRS
Business Administrator, Anesthesia Specialists at Sentara Heart Hospital

Transesophageal Echocardiography

An anesthesiologist may use transesophageal  echocardiography (TEE) for monitoring and/or diagnostic purposes.

To establish conditions such as myocardial ischemia or cardiac valve disorders, the anesthesiologist will be utilizing the transesophageal echo for diagnostic purposes. In this case, you can and should bill separately for the TEE in addition to the anesthesia. When you bill for both the anesthesia and the TEE, you must append the modifier 59 (Distinct Procedural Service) to this procedure or NCCI will consider the TEE bundled with the anesthesia – which will result in zero reimbursement for the TEE that your anesthesiologist performed. Do not leave this money out there! An important tip to remember here is the anesthesiologist must perform the placement, image acquisition, and interpretation (including a written report) in order to correctly bill for these services. Codes 93312 and 93315 are not bundled into the anesthesia services.

When a TEE is performed by an anesthesiologist for monitoring purposes only, you may not bill separately for the TEE. Code 93318 bundled into the anesthesia services.

One Lung Ventilation (OLV)

When your anesthesiologist utilizes on lung ventilation (OLV) and you do not use the correct code – You are leaving money on the table!  Why? Because the base is higher for OLV. You must remember to check the alternate codes for OLV, which will result in a higher base.

Example:  00540 is a 12 base, but 00541 (utilizing OLV) is a 15 base. The increase of three base units results in higher reimbursement – and that is money.

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