Reviewed on May 22, 2015; no changes to content
Check steps 3, 6, and 8 to prevent costly overcoding mistakes.
CPT® 2015 packs a lot of detail into its new code for transesophageal echocardiography used during transcatheter procedures on the heart and great vessels. Here’s a piece by piece look at the new code descriptor:
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93355, Echocardiography, transesophageal (TEE) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s) (e.g., TAVR, transcathether pulmonary valve replacement, mitral valve repair, paravalvular regurgitation repair, left atrial appendage occlusion/closure, ventricular septal defect closure) (peri- and intra-procedural), real-time image acquisition and documentation, guidance with quantitative measurements, probe manipulation, interpretation, and report, including diagnostic transesophageal echocardiography and, when performed, administration of ultrasound contrast, Doppler, color flow, and 3D.
Note: CPT® 2015 codes go into effect Jan. 1, 2015.
1. Start at the Beginning: TEE
The first element you need to know about 93355 is that it applies to transesophageal echocardiography (TEE).
Transesophageal refers to a service performed through the esophagus, the tube from the mouth to the stomach. For TEE, the provider inserts an ultrasound probe with a transducer into the esophagus. The transducer sends out sound waves and receives the echoes to create an image on the computer screen. By placing the probe in the esophagus, which is directly behind the heart, the physician can see the heart without a lot of other structures in the way.
CPT® includes other codes for TEE, specifically 93312-93318. As you get to know new code 93355, be sure to contrast it in particular against the code you’re likely familiar with for TEE monitoring, 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).
2. Understand the Importance of Transcatheter Examples
The next element of 93355 is that the code is “for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s) (e.g., TAVR, transcathether pulmonary valve replacement, mitral valve repair, paravalvular regurgitation repair, left atrial appendage occlusion/closure, ventricular septal defect closure).”
To simplify that a little more, you’ll report 93355 for a provider who uses TEE to help visualize the heart or great vessels during a transcatheter structural intervention on those structures.
Keep in mind that the procedures CPT® lists in the code descriptor are examples only, so you’ll be able to use 93355 for guidance during other transcatheter heart and great vessel structural interventions, too.
3. Count Pre- and Post- TEEs, Too
Be sure you don’t miss the next part of the code descriptor that indicates it includes both “peri- and intra-procedural.”
The prefix peri- means about or near, and intra- means within. So 93355 will represent TEE services performed immediately before, during, and immediately after the related surgical procedure.
4. Review the Guidelines for Documentation Needs
Code 93355 also specifies that it includes “real-time image acquisition and documentation.”
The documentation element is similar to the existing CPT® guideline for echocardiography that “Pertinent images, videotape, and/or digital data are archived for permanent storage and are available for subsequent review. Use of echocardiography not meeting these criteria is not separately reportable.”
5. Look for Measurements, Not Just Guidance
The next bit of the descriptor offers more insights into what you can expect to see in the documentation for 93355. Rather than simply indicating the use of TEE for guidance of the transcatheter procedure, the provider may also document various quantitative measurements he takes using the TEE. Quantitative refers to measuring the quantity or amount of something, rather than simply noting its presence or giving a rough estimate. Examples of structures measured during TEE include the heart, its chambers, valves, and walls.
6. Don’t Double Dip for Moving the Probe
The code descriptor also clarifies that 93355 includes probe manipulation. In other words, you’ll report the code only once regardless of the number of times the provider moves the probe to get different views.
7. Ensure Interpretation and Report Meet Requirements
Another key element of 93355 is the physician’s interpretation and report.
This is another section that matches existing CPT® guidelines for echocardiography: “Report of an echocardiographic study, whether complete or limited, includes an interpretation of all obtained information, documentation of all clinically relevant findings including quantitative measurements obtained, plus a description of any recognized abnormalities.” Adding the guideline information to the code descriptor will help keep your coding on target.
8. Don’t Report Related Diagnostic TEE Separately
CPT® helpfully answers the question of whether 93355 includes diagnostic TEE in the section of the descriptor that states “including diagnostic transesophageal echocardiography.” That clarification will help you remember not to report diagnostic TEE separately.
9. Clarify Services Included But Not Required
You’ve finally made it to the end of the code descriptor. The last section includes services that the code does not require but that it does include when the provider performs them. These services are “administration of ultrasound contrast, Doppler, color flow, and 3D.”
Proper use of 93355 will depend heavily on knowing which components the code includes, so you don’t report the components using additional codes, says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department. This final bit of the descriptor will help remind you not to report these ultrasound services separately.
