Wiki New tee code 93355

[aparscal]

I have a tee question. We have been billing the new tee code 93355 and mcr has been denying our code indicating the procedure code is inconsistent with the place of service. If anyone has any literature can you give us some help with this new code.

 

[Chlrtrep]

I have a tee question. We have been billing the new tee code 93355 and mcr has been denying our code indicating the procedure code is inconsistent with the place of service. If anyone has any literature can you give us some help with this new code.

Are the TEE is are coding/charging being done during transcatheter intracardic procedures?



Echocardiography, transesophageal (TEE) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s) (eg,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


2015: For 2015, the CPT Editorial Panel approved the addition of code 93355 to report interventional transesophageal echocardiography. This code includes guidance, real-time image acquisition, documentation and interpretation during transcatheter intracardic procedures. 2014. Source: CPT(R) Editorial Summary of Panel Actions February, 2014

 

[aparscal]

new tee 93355

Here is the report, and the only other procedures that are done during that admit is the actual AVR, the POS is a 21, these procedures are done inpt.

An old lady with a history of severe mitral and
aortic regurgitation, as well as severe pulmonary hypertension and some
degree of tricuspid regurgitation. Intraoperative transesophageal echo with
3D imaging of the mitral valve is requested by Dr. for further
assessment.
DESCRIPTION OF PROCEDURE: Informed consent was obtained by Dr.
Procedure was performed in the operating room with the patient orotracheally
intubated and under general anesthesia. The Omniplane probe was advanced
without difficulty to the posterior pharynx and to the mid esophageal and
transgastric positions, and a complete intraoperative transesophageal echo
was performed. Patient tolerated the procedure well without apparent
complication.
FINDINGS:
1. The left ventricle is at the upper limits of normal size to mildly
enlarged. There are no segmental wall motion abnormalities seen.
Overall, LVEF is in the range of 50% to 55%..
2. The right ventricle appears to be at the upper limits of normal size.
RV function is preserved.
3. There is moderate-to-severe left atrial enlargement. The left atrial
appendage is without spontaneous echo contrast or thrombus. The right
atrium is mildly to moderately enlarged.
4. The mitral valve is quite abnormal with severe apical tethering. There
is marked restriction in the mobility of the posterior mitral valve
leaflet. There is some restriction in mobility of the anterior mitral
valve leaflet with focal calcification seen. There is really no hockey-
stick type contour and there does not appear to be commissural fusion
or significant thickening of the subvalvular apparatus. There is
severe central MR.
5. The aortic valve is trileaflet. There is also thickening and
restricted mobility of the aortic valve leaflets. The aortic valve
annulus measures 2.1 cm. The aortic root is normal in size. The
sinotubular junction is calcified measuring 2.1 cm. The ascending
aorta is normal in size. Mild-to-moderate laminated plaque is noted in
the thoracic aorta. There is no evidence of dissection.
6. The tricuspid valve is normal. There is 1++ or at most 1 to 2+ TR
seen.
7. The pulmonic valve is normal. There is 1+ PI.
8. The coronary sinus is normal in caliber and drains into the right
atrium.
9. There is no PFO, ASD, or PDA. No bubbles noted across from right to
left with administration of sterile agitated IV saline contrast.
10.A 3D imaging of the mitral valve was also performed which does
demonstrate restricted mobility and apical tethering of the valve
leaflets

 

[j.monday7814]

I don't see it listed as an inpatient only procedure so at the very least you should be able to bill it under POS 21 or 22. What POS have you been billing and what procedures are they performing this with?

 

[BMWilliams]

The 93355 is only for the inpt procedures, ie: TAVR. the 93318 still active code for the TEE.

 

[j.monday7814]

The 93355 is only for the inpt procedures, ie: TAVR. the 93318 still active code for the TEE.

the POS of service isn't specified in the description of the code so we can't assume it can only be billed as inpatient just because TAVR is inpatient only. it is to be billed during any structural heart procedure which could be inpatient or outpatient.