Part B Insider (Multispecialty) Coding Alert

Published on Tue Aug 19, 2003 PDF

Time to start digging back through your files. As of July 1, you can once again receive payment for transesophogeal echocardiography (TEE) services (93312-93317) along with other anesthetic, as long as you use modifier -59 (Distinct procedural service), according to the latest National Correct Coding Initiative. You can even go back and rebill for TEE services that the carriers denied from January to June based on this now-defunct edit.

The catch: Medicare will only cover TEE separate from anesthesia if it's for diagnostic purposes. TEE for monitoring purposes won't receive any reimbursement.

Sometimes, "the doctor's not even aware when he's doing the actual procedure itself whether it's going to be for diagnostic or monitoring," says coder Kelly Dennis with Perfect Office Solutions in Leesburg Fla. Carrier Trailblazer says TEE may switch from monitoring to diagnostic mode to evaluate the function of a newly placed prosthetic valve or unanticipated hemodynamic problems in a surgical patient.

To count as diagnostic, TEE must be ordered by the operating surgeon, who must receive test results and reference them in his operative report, Trailblazer says. Also, the operator must maintain a recording of the study, just as with electively scheduled studies.

"If you're doing something for a diagnostic purpose, that means they expect to see diagnostic reports," Dennis says. "That's almost a no-brainer."

Generally, with diagnostic TEE, "you're using it to find out whether or not the patient needs additional surgery," says Michele Howell, practice administrator with Advanced Anesthesia Associates in Saginaw, Mich. Instead of using it to monitor the patient's heart rate, pulse and other signs throughout a surgery, operators will use it to diagnose a problem and see whether a surgeon has solved it yet.

Not all TEE codes require a written report for diagnostic purposes, Howell says: 93313 just requires that you document probe insertion.