Anesthesia Coding Alert

Check your knowledge against these scenarios With so many possibilities for reporting TEE services, be sure you're choosing the correct codes and reporting them when you should. Check your knowledge against our experts' knowledge in these common situations: Question: Your anesthesiologist administers a complete Doppler flow study in addition to TEE probe placement during a patient's case. Can you code it separately?

Answer: Because the Doppler study is separate from the TEE probe placement, you can bill for both procedures. Report +93320 (Doppler electrocardiography, pulsed wave and/or continuous wave with spectral display [list separately in addition to codes for echocardiography imaging]; complete) along with the appropriate TEE code. Append modifier 59 (Distinct procedural service) to the Doppler code to show that it is a separate service. Question: Your anesthesiologist uses TEE as  additional monitoring during a patient's case. Can you report it in addition to the case anesthesia? 

Answer: You can report the TEE, but don't expect to get paid for it. Most carriers only reimburse TEE when the anesthesiologist uses it for diagnostic purposes, not simple monitoring. But you should still report the service with 93318 to keep your claim complete and to track data. Question: Can the anesthesiologist use TEE for noncardiac cases?

Answer: Yes, some groups see a new trend toward using TEE during noncardiac cases. That's because the anesthesiologist decides to use TEE based on the patient's preoperative assessment and condition rather than the type of procedure being performed.

Noncardiac cases that might merit TEE include treatment of kidney tumors that have eroded into the vena cava, liver transplantations for end-stage liver disease, and surgery to locate foreign bodies such as bullet fragments and emboli during orthopedic cases.