Anesthesia Coding Alert

Transesophageal echocardiography (TEE) is a diagnostic procedure and monitoring tool that anesthesiologists are often asked to assist with or perform. Many local Medicare carriers, however, are unclear regarding whether or how anesthesiologists are to be reimbursed for their involvement in the procedure. Before coding for TEE, you should ensure that the anesthesia provider's TEE training (if the carrier requires it) and the role that he or she played during the procedure are documented so the correct codes can be used. Coding Options for TEE The TEE codes (93312-93318) are differentiated by whether the procedure is performed on a patient with congenital cardiac anomalies and by what portion of the procedure the physician handled. Codes 93312 (Echocar-diography, transesophageal, real time with image documentation [2D] [with or without M-mode recording]; including probe placement, image acquisition, interpretation and report) and CPT 93313 ( placement of transesophageal probe only) are commonly used to report TEE procedures, with many anesthesiologists only billing 93313 for probe placement. Even so, coders such as Cindy Clark, coding supervisor with the physician group Anesthesiology Consultants in Savannah, Ga., say that getting reimbursed is not always easy.

"We have one physician in our group who has the training for placing the TEE probe," she says, "so we only bill 93313 for the TEE placement. We attach a copy of the anesthetic record that indicates the TEE probe was placed and which doctor placed it, but we still have difficulty getting the code paid."

Code 93318 (Echocardiography, transesophageal [TEE] for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing [continuous] assessment of [dynamically changing] cardiac pumping function and to therapeutic measures on an immediate time basis) is appropriate for monitoring purposes when the physician is providing anesthesia during cardiac surgery, says Carla Thibodeaux, CPC, anesthesia coder with Tejas Anesthesia in San Antonio. It is often reported with modifier -26 (Professional component) because the physician does not usually own the equipment. However, because the code is relatively new, Thibodeaux points out that there may be stipulations attached such as whether the anesthesiologist needs special training certifications or whether there needs to be a formal report in the patient's medical record to bill for and receive reimbursement. Some carriers' policies also state that this monitoring code is not a covered service intraoperatively.

Coding Depends on Training The entire TEE procedure includes several different activities placing the probe, acquiring the test image, interpreting the test results and reporting the results. Many anesthesiologists, such as the physician in Clark's group, are only trained to perform probe placement. But if your physicians are trained and certified to perform other aspects of the procedure, coding can be handled several ways, depending on the anesthesiologist's [...]