Anesthesia Coding Alert

Software and templates can make all the difference in successfully coding TEEAnesthesiologists often use transesophageal echocardiography (TEE) during cardiovascular cases. Some anesthesiologists may not be sure which parts of the service carriers reimburse and exactly what type of documentation you need to code the case properly. Use these expert tips to get your documentation and coding up to par.Remember: Only report the portion of the service your anesthesiologist provides. "We also add modifier 26 (Professional component)," says Judy A. Wilson, CPC, CPC-H, CPC-P, CPC-I, CPC-ANEST, CMBSI, CMRS, with Anesthesia Specialists in Virginia Beach, Va. Reporting modifier 26 shows that your physician finished the test but does not own the equipment. The anesthesiologist must also provide a written report if he does the TEE, Wilson adds. And the anesthesiologist should be TEE certified, according to many insurance companies.Know Your TEE CodesCPT 2008 includes several codes for TEE, but some apply strictly to cardiologists rather than anesthesiologists. The complete group of TEE codes includes:• 93312 -- Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report.Code 93312 may be appropriate for those anesthesiologists who have credentials to perform the entire TEE procedure, interpretation and report.
• 93313 -- ... placement of transesophageal probe only.Code 93313 doesn't include the TEE interpretation and report. Submit 93313 when your anesthesiologist places the probe but a cardiologist performs the interpretation and report.
• 93314 -- ... image acquisition, interpretation and report only.Code 93314 coincides with 93313. If your anesthesiologist reports 93313, the cardiologist must report 93314.
• 93315 -- Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report.You may be able to report this code if your anesthesiologist is credentialed to perform the entire TEE procedure, especially if he concentrates on cardiac anesthesia.

• 93316 -- ... placement of transesophageal probe only
• 93317 -- ... image acquisition, interpretation and report only.Codes 93316 and 93317 have the same extended descriptors as 93313 and 93314. Choose the correct code based on whether the patient has congenital heart problems.Take note: Code 93315 is the complete service. You should bill 93316-93317 only if the anesthesiologist didn't provide all services described by 93315.
• 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.Your anesthesiologist might report 93318 most often, due to using TEE probes for monitoring.Red flag: Some carriers do not pay for 93318 because the global anesthesia fee includes monitoring. Because 93318 is not billable during anesthesia, not reporting it may be the safest option -- if a payer such as Medicare does reimburse it, you may have to [...]