Anesthesia Coding Alert

Question: Our physician performed TEG (thrombelastography) during a coronary artery bypass graft case. Medicare denies our claim of CPT 85390 (Fibrinolysins or coagulopathy screen, interpretation and report) with modifier -26 (Professional component). How should I code this case?

Illinois Subscriber Answer: Physicians use TEG to assess anticoagulation during heart surgery or other cases in which coagulation needs to be monitored. Certified technicians -- rather than anesthesiologists -- normally conduct the procedure and monitor the equipment. If your physician conducts the monitoring, however, most groups consider it part of the global fee as are all other monitors, and therefore should not be coded separately.

Because anesthesiologists rarely conduct TEG, also consider that the physician might have written TEG by mistake or you might be misreading his handwriting. Before assuming that this is TEG, verify whether it should be another service such as TEE (transesophageal echocardiography, codes 93312-93318) instead.