Cardiology Coding Alert

Question: Our cardiologist often performs continuous monitoring TEEs on pediatric patients in conjunction with a cardiac cath requiring multiple images. He must remain with the patient throughout the procedure, which can be prolonged. We now bill 93318-22 and attach supporting documentation showing the numerous images and the face-to-face time spent with the patient during the cath procedure. Is there is a more appropriate way to report this service?

Montana Subscriber

Answer: In the Medicare fee schedule, 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) has been designated a status C code, which means payment for the procedure is determined by local Medicare carriers, notes Gay Boughton-Barnes, CPC, MPC, CCS-P, chief medical compliance officer for the University of Oklahoma Medical Center in Tulsa.

Because the procedure is for continuous assessment, the local carrier has probably factored the time into the value assigned to the code, and therefore appending modifier -22 (unusual procedural services) may not be appropriate. If the cardiologist encountered something unusual while placing or removing the device, modifier -22 could be appended to indicate the additional time and/or work involved in performing the procedure, but this is not the case here.

If the cardiologist feels the heart cath required additional time and effort (possibly because of any anatomical difficulties encountered), modifier -22 would be more appropriately appended to the correct cardiac catheterization code.