Anesthesia Coding Alert

Question: What type of certification is required for anesthesiologists to bill for the professional component of 93312? They currently have passed the perioperative transesophageal echocardiography (TEE) exam, but is it necessary to obtain board certification?

Oklahoma Subscriber

Answer: Typically, a practice or facility sets the requirement. For instance, some hospitals require certification for the physicians performing TEEs. At one point, UnitedHealthcare discussed requiring certification for billing TEE, but that never came to fruition. You can check your specific payer. Medicare expects someone who performs a TEE to be qualified to do so. As your physicians passed the TEE examination, they are qualified to bill the professional component of 93312 (>Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report).

Because your group is in a Novitas Medicare coverage area, you should be aware of the documentation requirements as outlined in Local Coverage Determination (LCD) L33579 and Billing and Coding Article A52868. You can find these in the Medicare Coverage Database at www.cms.gov/medicare-coverage-database/search.aspx.

According to the Documentation Requirements of Article A52868:

• “Each service requires a formal written report with interpretation. This report should be kept on file with copies of image documentation (paper or tape) for review if requested. All appropriate measurements should be included in the report.”
• “A Doppler interrogation should state the modes used and should give both qualitative and quantitative information.”
• “Documentation of the qualifications of personnel performing tests, as described in the Indications section of the LCD, should be available on request.”