December 29, 2008

Our Compliance department recently fielded a question regarding the appropriate coding for intraoperative transesophageal echocardiographic (TEE) monitoring. The question, specifically, was whether it would be appropriate to report the placement of a TEE probe with CPT™ code 93313 for monitoring purposes. The answer is no, as confirmed in correspondence with the AMA CPT Education and Information Services.

The correct code for the TEE service most frequently performed by anesthesiologists, for intraoperative monitoring, is:

• 93318 Echocardiography, transesophageal (TEE) for monitoring purposes, including probe placement, real-time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis.

As explained in the American Society of Anesthesiologists’ Statement on Transesophageal Echocardiography, which was last updated on September 2, 2008, this code is used when the patient’s condition “requires repetitive evaluation of cardiac function in order to guide ongoing management” or “to guide surgical interventions (e.g., myocardial revascularization, valvular competence and repair of congenital hearts defects) and to guide pharmacological support and/or fluid administration in the perioperative period.” Intraoperative TEE monitoring is typically indicated in patients with histories of congestive heart failure, severe ischemic heart disease, aortic aneurysm, major trauma and burns, among other conditions.

For the sake of completeness, we should mention that ASA also published Practice Guidelines for Perioperative Transesophageal Echocardiography in April 1996 in Anesthesiology. Purchase copies or download a pdf version from the ASA Publications Department.

93318 does not require a permanent report or permanent images. Documentation in the anesthesia record is sufficient. This is one critical difference between 93318 and the diagnostic TEE codes (93312, 93314, 93315, and 93317), all of which require placing in the patient’s medical record a permanent report of pathologic dysfunction and cardiac anatomic abnormalities that may be more or less chronic.

The code about which an ABC client asked, 93313 (Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); placement of transesophageal probe only) does not describe the monitoring service performed by an anesthesiologist manipulating a TEE probe; by its terms, 93313 (like code 93316) is used to report the placement of the probe only and does not include any monitoring or image interpretation.

As always, we invite ABC clients with questions about billing and compliance to consult with their account managers. If you are not a current client of ABC and would like further clarification please email us at info@anesthesiallc.com.