Transesophageal Echocardiogram

michiboo

Networker
Messages
89
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I have provider who wants to keep billing 93312, 93320 and 93325, but I don't see where 93320 or 93325 is valid based on the documentation, maybe someone can help me read it and understand if I should be also billing 93320 and 93325 please!!!!!





SEDATION:
Versed 5 and fentanyl 100.

PREOPERATIVE DIAGNOSIS:
Atrial fibrillation.

POSTOPERATIVE DIAGNOSIS:
Atrial fibrillation.

COMPLICATIONS:
None.

SPECIMEN TAKEN:
None.

ESTIMATED BLOOD LOSS:
Zero.

INDICATION FOR PROCEDURE:
Briefly, xxxxx 61-year-old gentleman with past medical
history of cardiomyopathy, persistent atrial fibrillation status post ablation.
He has developed recurrent atrial fibrillation post ablation. He is seen,
examined, and deemed appropriate for transesophageal echo to rule out left
atrial thrombus prior to cardioversion procedure.

1. Left ventricle EF 45%.
2. Left atrium: Grossly left atrium is severely dilated. There is no thrombus.
3. Left atrial appendage: There is no thrombus.
4. Mitral valve: There is trace mitral regurgitation.
5. Aortic valve: The aortic valve is trileaflet. There was trace central
aortic regurgitation. There is no evidence of aortic stenosis.
6. Tricuspid valve: There is trace tricuspid regurgitation.

7. Atrial septum: There is evidence of interatrial shunt, which is consistent
with previous transseptal puncture site.
8. Pericardium: There is no pericardial effusion.
9. Aorta: The aortic root measures 4 cm.
 

kathrynw

Networker
Administrator
Messages
93
Location
Grantsville, UT
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Hi,
Below is the clinical responsibility for 93320 and 93325. These might help you in dissecting the documentation. Hopefully the physician is documenting more than what is provided here and that will help you determine. As he should be documenting words like, Doppler, or color-flow study etc.
93320-
Clinical Responsibility
The provider performs Doppler echocardiography using pulsed wave and/or continuous wave with a spectral display for a complete study. Doppler echocardiography is a diagnostic procedure based on the Doppler effect of sound. An echocardiograph uses high–frequency sound waves to assess the velocity and direction of blood flow in the cardiac arteries. The sound waves are transmitted into the body, bounce back, and are again captured by a device called a transducer. These captured waves are converted into images with the help of advanced digital processing technology. At the beginning of the procedure the subject (the person on whom the procedure is performed) is instructed to take off his clothing to the waist level. Women are provided a gown to wear. The person lies down on the examination table. During the examination the room will remain dimly–lit. First the sonographer will apply a gel on the chest wall or thorax of the subject. A number of sticky electrodes will be attached on the chest skin of the subject to receive an EKG report during the test. The sonographer will hold a small hand–held instrument known as the transducer and will move the device over the gel–smeared chest wall skin of the subject. The Doppler transducer is a different one than the normal ECHO transducer. The sonographer moves the transducer at various angles and at different positions over the location of the heart so that a complete picture of the heart can be obtained. The transducer transmits powerful sound waves that will pass through the gel layer and breast bones and bounce back upon falling onto the heart. To achieve better image recording, the sound waves should be targeted as parallel to the blood flow as possible. The echoes received from the heart and the RBCs in blood are converted by a complex computer program into two–dimensional images of the heart that will be displayed on a computer screen. This Doppler–ECHO recording is stored on a videotape or other storage media and later is interpreted by the cardiologist. Usually the entire process takes less than one hour to complete.

93225-The provider performs Doppler echocardiography, a diagnostic procedure based on the Doppler effect of sound, color flow velocity mapping, a two–dimensional image representation of blood flow in the heart that shows the velocity and direction of blood flow in different colors.
Clinical Responsibility
At the beginning of the procedure the sonographer applies a gel on the patient's chest wall or thorax. The sonographer moves a transducer over the gel–smeared chest wall at various angles and at different positions over the heart so that a complete picture of the heart can be obtained. To achieve better image recording, the sound waves should be targeted as parallel to the blood flow as possible. The echoes received from the heart and the RBCs in the blood are converted by a complex computer program into two–dimensional images of the heart that will be displayed on a computer screen. The computer program adds on more specific color layers that indicate blood flow pattern in a clearer way.
An echocardiograph uses high–frequency sound waves to assess the velocity and direction of blood flow in the cardiac arteries. The sound waves are transmitted into the body, bounce back, and are again captured by a transducer. These captured waves are converted into images with the help of advanced digital processing technology. The speed and the direction of blood flowing in normal vessels (laminar flow) are synchronized with the pumping action of the heart, and the speed of the red blood cells moving along the flow of blood in the arteries in a particular region is always the same. But when there is any abnormality in the vessel (e.g., a blockage, narrowing, or leakage.), the flow pattern and speed become irregular (turbulent flow) which is easily detected by the echocardiograph and reproduced as images in a screen. The Doppler transducer is different than the normal echo transducer.
 
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