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Tee - I am new with billing

  1. #1
    Default Tee - I am new with billing
    Medical Coding Books
    I am new with billing out TEE can someone help me with which Code this would be
    Thank you
    Lindsey



    TRANSESOPHAGEAL ECHOCARDIOGRAM

    INDICATIONS: This is an 80-year-old Caucasian female who presented with
    elevated temperature as well as elevated white count and with mental status
    changes. She is being evaluated for possible endocarditis.

    MEDICATION USED: IV Versed, IV Fentanyl.

    VITAL SIGNS: Both pre and post were within normal limits.

    PROCEDURE: After explaining the risks, benefits, and alternatives of the
    procedure to the patient in detail and answering all questions to
    satisfaction, an informed consent was obtained in writing. The patient denied
    having eaten food in the past six hours. The patient denied any dysphagia or
    odynophagia. The patient denied any loose teeth. The patient was then
    connected to continuous pulse oximetry, automated blood pressure monitor and
    electrocardiographic monitoring. Oxygen was administered by nasal canula
    continuously. The patient was placed in the full upright position and the
    posterior oropharynx was anesthetized with Cetacaine spray and viscous
    lidocaine. Once complete suppression of the gag reflex was obtained, the
    patient was then placed in the left lateral decubitus position. The neck was
    flexed, and bite block was placed in the patient's mouth. Sedation was
    administered intravenously. Once adequate sedation was achieved, a
    well-lubricated ante-flex TTE multipoint intraesophageal echocardiographic
    probe was inserted into the midline posterior oropharynx under digital
    guidance. General pressure was applied as the patient swallowed and the
    esophagus was intubated without difficulty. The scope was advanced to the
    level of gastric fundus without encountering resistance. Multipoint images of
    various cardiac structures were obtained from transesophageal views. The
    intra-atrial septum was assessed by application of color-flow Doppler as well
    as agitated saline. The scope was then rotated approximately 180 degrees and
    withdrawn, visualizing the length of the aorta including the arch. The scope
    was the slowly withdrawn as the patient was continually suctioned. The
    patient tolerated the procedure well with no foreseen complications.

    The patient tolerated the procedure well without any foreseen complication
    and was then transferred back to the patient's room in stable and
    satisfactory condition.

    SUMMARY OF FINDINGS:

    MITRAL VALVE: The mitral valve leaflet demonstrated mild to moderate mitral
    valve regurgitation secondary to mitral valve leaflet prolapse. Blood
    pressure was 145/55. There was no significant evidence of mass, thrombus, or
    vegetation noted.

    AORTIC VALVE: The aortic valve demonstrated trileaflet aortic valve with
    sclerotic trileaflet aortic valve. Noncoronary cause was noted with


    heterogenous soft tissue density suggestive of possible of endocarditis versus
    fibroelastoma. There was also tissue density noted on the aortic surface,
    which was mobile in nature and this was more of a soft tissue density. It did
    have some mobility as well as very circumferential heterogenous density and
    noncoronary cause with echo lucency noted as well. There was trace aortic
    insufficiency noted.

    DIMENSIONS: The aortic annulus measured 2.31 cm, sinus at 3.0 cm, and the
    sinus tubular junction 2.47 cm and the proximal roots measured 2.60 cm.

    LEFT ATRIUM: The left atrium was anatomically normal in size and function
    with no significant evidence of mass, thrombus or spontaneous echo contrast.

    LEFT ATRIAL APPENDAGE: The left atrial appendage was anatomically normal in
    structure and function with no significant evidence of mass, thrombus or
    spontaneous echo contrast. The inferior velocity was 0.53 meters/second and
    outflow velocity 0.5 meters/second.

    TRICUSPID VALVE: The tricuspid valve was anatomically normal in structure.
    There was trace tricuspid regurgitation noted. There was no significant
    evidence of mass, vegetation or thrombus noted. The pacemaker wire was noted
    transversely in the tricuspid valve which was intact with no vegetation noted
    and no echodensity noted on the tricuspid valve. The pacemaker lead was well
    visualized transversing from the superior vena cava through the right atrium
    into the right ventricle. There was also noted too, pacemaker lead 1 going to
    the right atrial appendage as well as one going through the tricuspid valve
    into the left ventricle. No ROVSP were obtained.

    INTRAATRIAL SEPTUM: The intraatrial septum was intact without any significant
    evidence of left to right shunt, no right to left shunt by color-flow as well
    as agitated saline study.


    LEFT VENTRICLE: The left ventricle was anatomically normal in size and
    function with no significant evidence of mass, thrombus or spontaneous echo
    contrast noted. Ejection fraction was approximately greater than 60%.

    AORTA: The aorta demonstrated mild to moderate heterogeneous plaquing
    throughout the aorta. There was no significant evidence of aneurysm, no
    dissection or dilatation.

    PULMONARY VALVE: The pulmonary valve was anatomically normal in structure and
    function with no significant evidence of mass, thrombus or vegetation. The
    annulus measured 1.97 cm.

    RIGHT VENTRICLE: The right ventricle was anatomically normal in size and
    function with no significant evidence of mass, thrombus or spontaneous echo
    contrast noted.

    PULMONARY ARTERY: The pulmonary arteries were anatomically normal in size and
    structure and was well visualized up to the level of the bifurcation with no
    significant evidence of thrombus or vegetation or pulmonary embolism.

    RIGHT ATRIUM: The right atrium was anatomically normal in size and function
    with no significant evidence of mass, thrombus or spontaneous echo contrast
    noted.



    PULMONARY VEINS: Pulmonary veins were not well visualized.

    IMPRESSION:
    1. Heterogenous soft tissue echo density noted on the noncoronary cause as
    well as a mobile density noted on the aortic surface of the aortic valve
    suggestive of vegetation versus Lambl excrescence vs possible
    fibroelastoma. But in regards to this patient presenting with
    elevated temperature as well as elevated white count with no source
    of infection, I do have a very high clinical suspicion for
    vegetation as well as the soft tissue density does have a
    heterogenity in nature, which is more suspicious for vegetation
    suggestive of endocarditis.
    2. Preserved left ventricular function.
    3. Mild to moderate mitral regurgitation with posterior mitral valve
    leaflet prolapse noted.
    4. Pacemaker wires noted without any significant vegetation or
    thrombus noted.
    5. No significant evidence of left to right shunt or atrial septal
    defect noted.
    6. Sclerotic trileaflet aortic valve.

    RECOMMENDATIONS:
    I do recommend this patient to be treated for endocarditis with antibiotics
    for the next four to six weeks. At which point, a repeat Transesophageal echo
    needs to be performed to evaluate for this heterogenous echo density soft
    tissue mass.

    We will continue to follow this patient inpatient as well as outpatient. The
    case was discussed with primary care physician as well as ordering physician.

  2. #2
    Location
    Richardson, TX
    Posts
    822
    Default
    TEE 93312
    Doppler 93320
    Doppler Color-flow 93325

    If was done in hosp add mod -26

    Hope that helps

    Julie D. CPC

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