Cardiology Coding Alert

Case Study:

Tackle This Tricky 93355 Case Study for TEE Coding Success

See how our coding expert answers this challenging subscriber question.

As you can see from the article “Reporting TEE services During Transcatheter Intracardiac Therapies? Here’s Howservices During Transcatheter Intracardiac Therapies? Here’s How,” reporting transesophageal echocardiography (TEE) code 93355 can be difficult because this is a very intricate code.

A subscriber recently wrote in with a challenging 93355 question. Take a look and see if you would know how to handle this situation.

Would You Know How to Handle This Scenario? Find Out

The case: A Codify Subscriber asks, “Based upon our past experience, when performed on the same day as procedures like TAVR and Watchman, 93355 is bundled into the procedure by Correct Coding Initiative (CCI) edits that no modifier will unlock. An issue this causes in our office is that the physician performing the 93355 is required to be in the OR but is not provided a means to receive credit (or RVU) for his work. Modifier 62 does not seem appropriate since we know this procedure is bundled into the primary (and the doctor doing the TEE is not a surgeon). Any suggestions regarding how to enter such a scenario into electronic EMR systems to allow this provider to also be recognized for his time and work? In our instance, the physician doing the 93355 is a separate physician than the doctor doing the procedure, but both are in the same cardiology practice.

What should you do?

Break Down This Solution

Currently, 93355 is reimbursed with TMVR because standard routine care hasn’t been determined/identified, says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee. However, most likely in the near future a CCI edit of 93355 with TMVR will occur.

Code 93355 now has a CCI edit with TAVR (2016) and Watchman (2017) due to standard routine use during procedure, Neighbors adds. It has been identified and determined that 90 percent of these procedures standardly and routinely use TEE guidance.

“When new procedures are created, it’s difficult to know exactly which components of a procedure will be included within the primary component procedural code,” Neighbors explains. “Code 93355 was originally approved for reimbursement for medically necessity due to other patient comorbidities.”

This code should have only been used on a case by case basis, not as a standard protocol, Neighbors continues. When a component of a procedure becomes a standard protocol and is used commonly by the specialty, in time, the commonly-used component gets reevaluated and may become included within the primary component procedure.

“So, basically, CCI edits cause a lot of extra work, and if an override is allowed, medical necessity is met, and all the components of the procedure are provided, then it’s appropriate to append the CPT® code with the necessary modifier and capture the procedure performed,” Neighbors adds.

“In my opinion, if there’s true patient comorbidity medical necessity that requires 93355 for unusual non-overlapping service (modifier XU) due to a life threatening or unusual circumstance and performed by a separate practitioner (modifier XP), report 93355,” Neighbors says. “This will not happen commonly and will be very rare. An appeal of medical necessity for additional reimbursement will be required and if approved (payers discretion), reimbursement of this component may take up to 60-90 days.”

Don’t Miss This Coding Tip

Code 93355 must be linked/attached to a different physician’s NPI number (modifier XP, separate physician who performed procedure) and its own claim form. It’s recommended that this component is not listed on the same claim form as the TMVR procedure even when the physicians work under the same Tax ID number.

“I also recommend a separate report be interpreted by the physician who performed this component of the procedure,” Neighbors says.