Clarifying TEE ’s Coding and Documentation Requirements (CPT 93312-93318)
Joette Derricks, CPC, CHC, CMPE, CSSGB
Vice President of Regulatory Affairs & Research, ABC
Several clients have inquired as to the documentation and correct coding and billing for Transesophageal Echocardiography (TEE) services. A TEE is a special diagnostic tool, which may be used by properly trained physicians (i.e., anesthesiologists, cardiologists) to benefit patient care. A separately reported TEE may be performed for monitoring and/or diagnostic purposes. However, many payers will only reimburse diagnostic studies.
For example, to establish conditions such as myocardial ischemia or cardiac valve disorders, the anesthesiologist will be utilizing the transesophageal echo for diagnostic purposes. In this case, when the anesthesiologist has the additional certification or documented training in residency, and is privileged by the hospital to do the complete procedure, the anesthesiologist can and should bill separately for the TEE in addition to the anesthesia. The correct CPT code for the complete procedure is 93312. When you bill for both the anesthesia and the TEE, the coder must append the modifier 59 (Distinct Procedural Service) to this procedure or the national Correct Coding edits (NCCI) will consider the TEE bundled with the anesthesia – which will result in zero reimbursement for the TEE that the anesthesiologist performed. When the entire diagnostic TEE is performed by the anesthesiologist, it is important to remember that the anesthesiologist must perform and document the probe placement, image acquisition retention and retrieval if requested, and a written interpretation and report in order to correctly bill for these services.
In cases when the anesthesiologist places the probe and another physician maintains the image acquired and does a written interpretation and report, the placement-only diagnostic TEE code 93313 is used with the 59 modifier. In order for the diagnostic TEE probe placement to be payable, some payers will be requiring the corresponding image acquisition, interpretation and report to be billed by the other physician.
This payer specific requirement is related to CPT coding rules which state, “Report of an echocardiographic study, whether complete or limited, includes an interpretation of all obtained information, documentation of all clinically relevant findings including quantitative measurements obtained, plus a description of any recognized abnormalities. Pertinent images, videotape, and/or digital data are archived for permanent storage and are available for subsequent review. Use of echocardiography not meeting these criteria is not separately reportable.”
However, the anesthesiologist should not be penalized if the other physician does not document or report the work that they do. Therefore, we recommend that when only the probe is placed for a diagnostic procedure the 99313-59 code should be reported and billed.
When a TEE is performed by an anesthesiologist for intraoperative monitoring purposes only, the probe placement may not be billed separately as CPT coding conventions do not allow an option for the placement to be separately billed from the total intraoperative monitoring service. In addition, many payers bundle the entire monitoring TEE code 93318 into the anesthesia services, or consider the monitoring as a non-payable service.As with all documentation, it is important that the anesthesiologist clearly document in the record whether the study is for diagnostic or monitoring purposes. TEE studies for monitoring billed as diagnostic, or diagnostic TEE studies without the necessary written report and pertinent images, would not withstand the scrutiny of an audit. This code is used when the patient’s condition, as described under 93312, requires repetitive evaluation of cardiac function in order to guide ongoing management. CPT code 93318 is unique in that no permanent images are created. Use Of Modifiers
As discussed earlier, if the TEE is performed for diagnostic purposes by the same anesthesiologist who is providing anesthesia for a separate procedure, modifier 59 should be appended to the TEE code to note that it is distinct and independent from the anesthesia service. If the anesthesiologist does not own the TEE equipment, she/he reports only the professional component of the TEE service and should append modifier 26 (Professional Component) to the TEE code, along with modifier 59.
Joette Derricks, CPC, CHC, CMPE, CSSGB serves as Vice President of Regulatory Affairs and Research for ABC. She has 30+ years of healthcare financial management and business experience. Knowledgeable in third-party reimbursement, coding and compliance issues, Ms. Derricks works to ensure client operations are both productive and profitable. She is a long-standing member of MGMA, HCCA, AAPC and other associations. She is also a sought-after nationally-acclaimed speaker, having presented at AHIMA, Ingenix, MGMA and HCCA national conferences. You can reach her at Joette.Derricks@AnesthesiaLLC.com.