Cardiology Coding Alert

Question: What requirements must be met to report a 93355 service correctly?

Alabama Subscriber

Answer: You must remember the following when reporting 93355 (Echocardiography, transesophageal (TEE) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s) ...):

• This code 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.  
• This 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). In other words, you'll report 93355 for a cardiologist who uses TEE to help visualize the heart or great vessels during a transcatheter structural intervention on those structures.
• This code includes the cardiologist's interpretation and report.
• In the documentation for 93355, you should look for measurements, not just guidance. 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.
• The descriptor for 93355 indicates that it includes both "peri- and intra-procedural." The prefix peri- means about or near, and intra- means within. So 93355 represents TEE services performed immediately before, during, and immediately after the related surgical procedure.
• This code includes probe manipulation, so you should report the code only once regardless of the number of times the provider moves the probe to get different views.
• You should not report diagnostic TEE separately when reporting 93355.
• Since 93355 includes "administration of ultrasound contrast, Doppler, color flow, and 3D," according to the descriptor, you cannot report these ultrasound services separately.