Cardiology Coding Alert

Think you don't need modifier 26 for 93314? Think again.

Transesophageal echocardiography (TEE) has long troubled coders who need to choose among the procedure's available codes (93312-93318). If you're fuzzy on which TEE code will bring in deserved reimbursement, take these tips from the experts.

Watch for Congenital and Global Clues

For a study that involves real-time image acquisition and documentation, you'll use a code from 93312-93314 (Echocardiography, transesophageal, real-time with image documentation [2D] [with or without M-mode recording]...), unless the procedure reveals a congenital cardiac abnormality. If the physician provides probe placement, then performs the exam and also dictates the report, you'll use code 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 doesn't perform the full service, look to the following options:

• 93313 -- ... placement of transesophageal probe only
• 93314 -- ... image acquisition, interpretation and report only.

Congenital: The other full-service TEE code is 93315 (Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report). As the definition indicates, it is specific to TEE for congenital cardiac anomalies. Again, CPT provides options if the physician performs only certain aspects of the service:

• 93316 -- ... placement of transesophageal probe only
• 93317 -- ... image acquisition, interpretation and report only.

Remember: You should not use 93315-93317 "when a congenital heart disease is suspected, but is not found on echocardiography evaluation. In this case, the noncongenital echocardiography codes should be used," according to CPT Assistant (December 1997).

Pointer: One common roadblock with billing for TEE is determining whether the procedure is for diagnostic (93312- 93317) or monitoring purposes (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). To bill for a diagnostic TEE, you'll need a written report. "When in doubt, query the provider," recommends Julie Drueppel, CPC, a billing coordinator in Lincoln, Neb.

Remember to Check for Professional/Technical

Ensure your coding tells the right story of what happened during the procedure by attaching the right modifiers. For many TEE procedures done in a hospital, you'll need to append modifier 26 (Professional component). "The facility that owns the equipment would receive the technical component," says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, president of Perfect Office Solutions, in Leesburg, Fla.

Exception: "93313 and 93316 are, by definition, for 'placement of transesophageal probe only' and, therefore, the 26 modifier is not applicable as the code definition itself is a professional service only," Drueppel says.

Example: A cardiologist needs to know whether a patient has chronic myocardial ischemia (414.8, Other specified forms of chronic ischemic heart disease) or cardiac valve disorder (395.x, Diseases of aortic valve). In the inpatient setting, after another physician places the probe, the cardiologist maneuvers the probe for image acquisition, interprets the findings, and creates a written report. If he finds no congenital abnormalities, you should report 93314. Append modifier 26 to indicate you're reporting only the physician's services.

Watch for Separately Reportable Doppler

Your cardiologist may decide that Doppler services are necessary for the patient in addition to the TEE. CPT indicates that you may report +93320 (Doppler echocardiography, pulsed wave and/or continuous wave with spectral display [List separately in addition to codes for echocardiographic imaging]; complete) or +93321 (... follow-up or limited study [List separately in addition to codes for echocardiographic imaging]) and +93325 (Doppler echocardiography color flow velocity mapping [List separately in addition to codes for echocardiography]) in addition to TEE codes 93312, 93314, 93315, and 93317.

Remember that these Doppler codes have professional and technical components, so you need to indicate that you are reporting only the professional component of each code, if that is the case.