aadair
Contributor
We are receiving denials from UH, Fidelis and Wellcare for our cardiac anesthesia billing for the TEE’s. An example billing is as follows:
00562
93503
36556-59
36620
76937-26
93312-26-59
93320-26-59
93325-26-59
Medicare LCD Policy 33579 Article A52868 gives clear guidelines about billing TEE’s with open heart surgery. On appeal, I include explanation under this LCD policy, TEE’s should be a covered expense when done for diagnostic purposes. We use an EMR. Our cardiac anesthesiologist performs a diagnostic TEE, documents findings within the EMR and reports to the cardiac surgeon any abnormal findings at the beginning of the case. The TEE is continued to be used by the anesthesiologist for monitoring and then at the end of the open heart repair, another diagnostic TEE is performed to verify patency of the repair, which is also documented in the EMR. We provide medical records along with the Medicare LCD policy citing this is a billable expense, however, the insurances are stating “insufficient documentation” even when we bracket where the TEE is performed on the EMR. The writing is small on the EMR so we have made “enlargements” of the image and still get denials. Any advice/recommendations from other cardiac anesthesia practices successfully billing and getting paid for TEE's would be greatly appreciated.
00562
93503
36556-59
36620
76937-26
93312-26-59
93320-26-59
93325-26-59
Medicare LCD Policy 33579 Article A52868 gives clear guidelines about billing TEE’s with open heart surgery. On appeal, I include explanation under this LCD policy, TEE’s should be a covered expense when done for diagnostic purposes. We use an EMR. Our cardiac anesthesiologist performs a diagnostic TEE, documents findings within the EMR and reports to the cardiac surgeon any abnormal findings at the beginning of the case. The TEE is continued to be used by the anesthesiologist for monitoring and then at the end of the open heart repair, another diagnostic TEE is performed to verify patency of the repair, which is also documented in the EMR. We provide medical records along with the Medicare LCD policy citing this is a billable expense, however, the insurances are stating “insufficient documentation” even when we bracket where the TEE is performed on the EMR. The writing is small on the EMR so we have made “enlargements” of the image and still get denials. Any advice/recommendations from other cardiac anesthesia practices successfully billing and getting paid for TEE's would be greatly appreciated.