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Anesthesia Coding Alert

You Be the Coder:

Getting Paid for TEEs

Published on Fri Nov 07, 2003

Question: How can we be reimbursed for TEEs (transesophageal echocardiography) with insertion and interpretation? Carriers deny claims with modifier -59 (Distinct procedural service) and modifier -26 (Professional component).

Maine Subscriber

Answer: Report 93312 (Echocardiography, transesophageal, real time with image documentation [2D] [with or without M-mode recording]; including probe placement, image acquisition, interpretation and report) if the physician performed all components of the procedure.
 
For cardiac patients, look at 93315 (Transesoph-ageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report). Most carriers have lists of specific diagnoses that support medical necessity for TEE, so start by ensuring that the diagnosis is on that list. Some commonly accepted diagnoses include 444.81 (Embolism and thrombosis of iliac artery), 458.9 (Hypotension, unspecified), 745.4 (Ventricular septal defect) and V42.1 (Heart replaced by transplant).
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