Anesthesia Coding Alert

Be sure to report cases correctly in new circumstances Anesthesiologists have used transesophageal echocardiography (TEE) during cardiac procedures for several years, which means the coding is old hat. But a new trend - using TEE during noncardiac cases - might be hitting your desk soon, and you need a solid understanding of the following concepts to report it correctly. Understand Which Codes Apply to You CPT includes several codes for TEE, but some normally apply to the cardiologist instead of the anesthesiologist. 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. Some anesthesiologists are qualified to perform the entire TEE procedure, interpretation and report. If you're reporting the complete service, you should append modifier -59 (Distinct procedural service) and include a separate diagnosis for Medicare.

93313 - ... placement of transesophageal probe only. This code does not include the interpretation and report; anesthesiologists report it when a cardiologist performs the interpretation and report. 

93314 - ... image acquisition, interpretation and report only. If the anesthesiologist reports 93313 for the case, a cardiologist must report 93314 to coincide with the anesthesiologist's work.

93315 - Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report

93316 - ... placement of transesophageal probe only. This is the same extended descriptor as 93313 but applies to patients with congenital heart problems.

93317 - ... image acquisition, interpretation and report only

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. Anesthesiologists primarily use TEE for monitoring purposes, so the code from the above list that many coders rely on is 93318. Caution: Remember that Medicare does not pay TEE for monitoring, says Scott Groudine, MD, an Albany, N.Y., anesthesiologist. Verify Your Doctor's Certification Before an anesthesiologist can perform TEE placement - for any type of case - he must complete training and be certified through the SCA (Society of Cardiovascular Anesthesiologists), says Darlene Ogbugadu, CPC, billing supervisor for the department of anesthesiology at Northwestern Medical Faculty Foundation in Chicago.

The American Society of Anesthesiologists (ASA) and SCA House of Delegates approved and published guidelines for TEE in 1996 that addressed more anesthesia-related issues. These included indications for the procedure, education requirements, training documentation, technical aspects of performing TEE, the use of TEE, and bundling issues when reporting the procedure.

Info: Guidelines for performing TEE continue to become stricter. Log on to the ASA's Web site (