Our anesthesiologists do a surgical TEE for the cardiologists when they are replacing Mitral or Aortic valves and also CABGs. 93312-59 is being denied 90% by all payers. 93355-59 (which I believe is the better code) is also being denied.
Medicare Remark code is CO-236: This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination that was provided on the same day . I've reviewed LCDs and still don't know what it is bundling with or is there another modifier that should be used. Please see TEE note below. I just wonder if anyone else has this issue and/or can explain how bill to get reimbursement for this code. Thank you.
Example billing:
33405 (anesthesia time billing) for Aortic valve replacement
36620 (surgical)
93355-59 (surgical)
On a separate claim we bill Central Venous Line
36556-59 (surgical)
76937-26 (radiological)
Procedure Performed: TEE
Preanesthesia Checklist: Patient identified, IV assessed, risks and benefits discussed, monitors and equipment assessed, procedure being performed at surgeon's request and anesthesia consent obtained.
General Procedure Information Diagnostic Indications for Echo: assessment of surgical repair, hemodynamic monitoring and assessment of valve function Physician Requesting Echo:
Location performed: OR Intubated Bite block placed Heart visualized Probe Insertion: Easy Probe Type: 3D and mulitplane Modalities: 3D, color flow mapping, pulse wave Doppler and continuous wave Doppler Echocardiographic and Doppler Measurements
Ventricles Right Ventricle: Cavity size normal. Hypertrophy not present. Thrombus not present. Global function normal. Left Ventricle:Cavity size normal. Hypertrophy present. Thrombus not present. Global Function normal. Ejection Fraction 60%. Other Ventricular Findings: Septal knob 1.28 cm Ventricular Regional Function: 1- Basal Anteroseptal: normal 2- Basal Anterior: normal 3- Basal Anterolateral: normal 4- Basal Inferolateral: normal 5- Basal Inferior: normal 6- Basal Inferoseptal: normal 7- Mid Anteroseptal: normal 8- Mid Anterior: normal 9- Mid Anterolateral: normal 10- Mid Inferolateral: normal 11- Mid Inferior: normal 12- Mid Inferoseptal: normal 13- Apical Anterior: normal 14- Apical Lateral: normal 15- Apical Inferior: normal 16- Apical Septal: normal 17- Apex: normal
Valves Aortic Valve: Annulus normal. Stenosis not present. Regurgitation none. Leaflets normal. Leaflet motions normal. Mitral Valve: Annulus normal. Stenosis not present. Regurgitation mild. Leaflets normal. Leaflet motions normal. Tricuspid Valve: Annulus normal. Stenosis not present. Regurgitation none. Leaflets normal. Leaflet motions normal. Pulmonic Valve: Annulus normal. Stenosis not present. Regurgitation mild. Other Valve Findings: Trace AI and MR central jet. Mild PI Potential exists for SAM AML 2.95 PML 1.6, C-sept 1.78 No gradient in LVOT nor turbulence in outflow tract.
Aorta Ascending Aorta: Size normal. Dissection not present. Aortic Arch: Size normal. Dissection not present. Descending Aorta: Size normal. Dissection not present.
Right Atrium: Size normal. Spontaneous echo contrast not present. Thrombus not present. Tumor not present. Device not present. Left Atrium: Size normal. Spontaneous echo contrast not present. Thrombus not present. Tumor not present. Device not present. Left atrial appendage normal.
Septa Atrial Septum: Intra-atrial septal morphology normal and lipomatous hypertrophy. Ventricular Septum: Intra-ventricular septum morphology normal.
Diastolic Function Measurements: Diastolic Dysfunction Grade= II (Pseudonormal) E= ms A= ms E/A Ratio= DT= ms S/D= IVRT= Other Findings Pericardium: normal Pleural Effusion: none Pulmonary Arteries: normal Pulmonary Venous Flow: normal Anesthesia Information Performed Personally Anesthesiologist: Echocardiogram Comments: No difficulty with probe insertion or manipulation. Prebypass: LVH. Normal RV function and size. No WMA. Valves as above with potential for SAM. No gradient or turbulence in LVOT. Postbypass: Normal rv and lv function. Valves unchanged. No gradient in LVOT. Aortic repair intact.
Medicare Remark code is CO-236: This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination that was provided on the same day . I've reviewed LCDs and still don't know what it is bundling with or is there another modifier that should be used. Please see TEE note below. I just wonder if anyone else has this issue and/or can explain how bill to get reimbursement for this code. Thank you.
Example billing:
33405 (anesthesia time billing) for Aortic valve replacement
36620 (surgical)
93355-59 (surgical)
On a separate claim we bill Central Venous Line
36556-59 (surgical)
76937-26 (radiological)
Procedure Performed: TEE
Preanesthesia Checklist: Patient identified, IV assessed, risks and benefits discussed, monitors and equipment assessed, procedure being performed at surgeon's request and anesthesia consent obtained.
General Procedure Information Diagnostic Indications for Echo: assessment of surgical repair, hemodynamic monitoring and assessment of valve function Physician Requesting Echo:
Location performed: OR Intubated Bite block placed Heart visualized Probe Insertion: Easy Probe Type: 3D and mulitplane Modalities: 3D, color flow mapping, pulse wave Doppler and continuous wave Doppler Echocardiographic and Doppler Measurements
Ventricles Right Ventricle: Cavity size normal. Hypertrophy not present. Thrombus not present. Global function normal. Left Ventricle:Cavity size normal. Hypertrophy present. Thrombus not present. Global Function normal. Ejection Fraction 60%. Other Ventricular Findings: Septal knob 1.28 cm Ventricular Regional Function: 1- Basal Anteroseptal: normal 2- Basal Anterior: normal 3- Basal Anterolateral: normal 4- Basal Inferolateral: normal 5- Basal Inferior: normal 6- Basal Inferoseptal: normal 7- Mid Anteroseptal: normal 8- Mid Anterior: normal 9- Mid Anterolateral: normal 10- Mid Inferolateral: normal 11- Mid Inferior: normal 12- Mid Inferoseptal: normal 13- Apical Anterior: normal 14- Apical Lateral: normal 15- Apical Inferior: normal 16- Apical Septal: normal 17- Apex: normal
Valves Aortic Valve: Annulus normal. Stenosis not present. Regurgitation none. Leaflets normal. Leaflet motions normal. Mitral Valve: Annulus normal. Stenosis not present. Regurgitation mild. Leaflets normal. Leaflet motions normal. Tricuspid Valve: Annulus normal. Stenosis not present. Regurgitation none. Leaflets normal. Leaflet motions normal. Pulmonic Valve: Annulus normal. Stenosis not present. Regurgitation mild. Other Valve Findings: Trace AI and MR central jet. Mild PI Potential exists for SAM AML 2.95 PML 1.6, C-sept 1.78 No gradient in LVOT nor turbulence in outflow tract.
Aorta Ascending Aorta: Size normal. Dissection not present. Aortic Arch: Size normal. Dissection not present. Descending Aorta: Size normal. Dissection not present.
Right Atrium: Size normal. Spontaneous echo contrast not present. Thrombus not present. Tumor not present. Device not present. Left Atrium: Size normal. Spontaneous echo contrast not present. Thrombus not present. Tumor not present. Device not present. Left atrial appendage normal.
Septa Atrial Septum: Intra-atrial septal morphology normal and lipomatous hypertrophy. Ventricular Septum: Intra-ventricular septum morphology normal.
Diastolic Function Measurements: Diastolic Dysfunction Grade= II (Pseudonormal) E= ms A= ms E/A Ratio= DT= ms S/D= IVRT= Other Findings Pericardium: normal Pleural Effusion: none Pulmonary Arteries: normal Pulmonary Venous Flow: normal Anesthesia Information Performed Personally Anesthesiologist: Echocardiogram Comments: No difficulty with probe insertion or manipulation. Prebypass: LVH. Normal RV function and size. No WMA. Valves as above with potential for SAM. No gradient or turbulence in LVOT. Postbypass: Normal rv and lv function. Valves unchanged. No gradient in LVOT. Aortic repair intact.