Cardiology Coding Alert

Spot the difference or forfeit reimbursement

Time to start digging through your files. As of July 1, you can once again receive payment for transesophageal echocardiography (TEE) services (93312-93317) along with other anesthetic, as long as you use modifier -59 (Distinct procedural service), according to the latest National Correct Coding Initiative.
 
You can even go back and rebill for TEE services that the carriers denied from January to June based on this now-defunct edit.
 
The catch: Medicare will only cover TEE separate from anesthesia if it's for diagnostic purposes. TEE for monitoring purposes won't receive any reimbursement.
 
"Sometimes, the physician's not even aware, when he's doing the procedure, whether it's going to be for diagnostic or monitoring," says coder Kelly Dennis with Perfect Office Solutions in Leesburg, Fla.
 
Trailblazer, the Medicare carrier for Texas and a range of other states, advises that TEE may switch from monitoring to diagnostic mode to evaluate the function of a newly placed prosthetic valve or unanticipated hemodynamic problems.
 
For it to count as diagnostic, the physician performing the interventional procedure must order the TEE and he must receive test results and reference them in his operative report, Trailblazer says.
 
Also, the operator must maintain a recording of the study, just as with electively scheduled studies.
 
"If you're doing something for a diagnostic purpose, that means they expect to see diagnostic reports," Dennis says. Generally, you use diagnostic TEE to find out whether the patient needs an additional intervention, says Michele Howell, a practice administrator in Saginaw, Mich. In addition to using it to monitor the patient's cardiac function throughout a procedure, operators use TEE to diagnose a problem such as persistently leaky valve after valve replacement surgery. Not all TEE codes require a written report for diagnostic purposes, Howell says: CPT 93313 just requires that you document probe insertion.