Once up on a time but not too long ago, did you know how
cardiovascular anesthesiologists used
devices to manage patients’ cardiovascular functions? The documentation of transesophageal
echocardiography with no doubt poses multiple questions as it contains various procedural choices
and so as anesthesia billing procedures.
Anesthesia billing guidelines keep changing and are not constant just like any other billing
guidelines. It’s always better to review present
CPT coding updates
and insurance companies’ policies. Cardiovascular anesthesiologists especially relied on three main
monitoring devices to manage patient’s cardiovascular issues or functions.
The development of transesophageal – TEE probe to monitor heart function through ultrasound from the
esophagus changed the scenario. Most of the anesthesia professionals find TEE probe as one of the
most useful monitors that provides a real time imaging of heart functions and especially during
critical and essential phases of procedures.
Anesthesia Billing for TEE:
Anesthesia billing and Coding for TEE is based on the same basic logic as for radiology and
ultrasound procedures: there is one code for placement of the probe-93313, one code for
interpretation of the images – 93314, and one for the comprehensive service 93312.
CPT Coding rules mention that “Report of an echocardiographic study, whether it’s complete or
limited, includes an interpretation of all obtained information, strong documentation of all
clinically relevant findings including quantitative measurements obtained, plus a description of any
recognized abnormalities. Pertinent images, videotape, or digital information are archived for
permanent storage and available for subsequent review. Use of echocardiography not meeting these
criteria is not separately reportable.”
CMS policy for reimbursable indications for intraoperative TEE: “The interpretation of TEE during
surgery is covered only when the surgeon or other physician has requested echocardiography for a
specific diagnostic reason .For a covered service, TEE should include a complete interpretation or a
report by the performing healthcare professional. Coverage for evaluation, however, is not allowed
for monitoring, technical trouble shooting, or any other purpose that does not meet the medical
necessity criteria for the diagnostic test.
When TEE is performed by an anesthesiologist for intraoperative monitoring purposes alone and the
probe placement might not be billed separately as CPT coding conventions do not allow an option or
choice for the placement to be separately billed from the total intraoperative monitoring service
TEE Documentation requirements for Anesthesia billing:
Documentation from a surgeon or other healthcare professionals requesting echocardiography for a
specific diagnostic reason:
The rationale for performing the study must be clearly documented in the medical record. The medical
record is supposed to indicate the above request either by an order in the medical record, or the
operative consent form, progress notes, or at the very least within the dictated echocardiography
report. It should also be clear if the intraoperative enteroscopy – IOE was performed for
diagnostic, monitoring, or research purposes.
A complete interpretation and report generated by the echocardiographer:
A final and complete written interpretation of all diagnostic echocardiography studies, including
TEE, therefore must be produced and must be maintained in the patient’s health record.
Diagnostic intraoperative TEE must be documented in the patient’s record with videotape or another
recording technique and the physician should submit or provide a written interpretation. “At a
minimum, a complete study should include ,2-D with or without M-mode measurements of left
ventricular end diastolic diameter, left ventricular end systolic diameter, left ventricular wall
thickness, left atrial diameter, aortic valve excursion, qualitative description of left ventricular
function and, as applies, a description of any technical limitations for particular cases.
Valid substitutes for the earlier parameters might be recorded, such as LV volumes, ejection
fraction and LV mass measurements.” Noridian, LCD L26723 o Best practices include submission of a
copy of the completed and signed TEE report with the anesthesia billing sheet.
TEE Codes:
93312 – Echocardiography, transesophageal, real time with image documentation (2D) with or without
M-mode recording includes probe placement, image acquisition, interpretation and report which
describes the entire TEE service when it is performed by a single physician or healthcare
professional with or without the assistance of a sonographer for image acquisition.
It’s used when the patient’s condition, just as mentioned and described under 93312, it requires
repetitive evaluation of cardiac function in order to guide ongoing management. Requires image
documentation and a written interpretation in order to satisfy the requirements of anesthesia
billing where the service can be used to describe intraoperative and non-intraoperative TEE
procedures.
The above service involves placement of the transesophageal probe, obtaining the appropriate images
and views, and critical analysis of the data or information. Those patients with increased or
highest risks of hemodynamic disturbances might require probe insertion and interpretation of the
echocardiogram. It is not limited to medical histories of congestive heart failure, severe ischemic
heart disease, valvular disease, aortic aneurysm, major trauma and burns.
It may also indicate certain procedures that involve great shifts in the patient’s volume status.
Such procedures might include vascular surgery, cardiac surgery, liver resection or transplantation,
extensive tumor resections and radical
orthopedic surgery. The use of TEE might
also indicate the central venous access that is contraindicated or difficult and is not possible to
adequately assess blood loss and replacement, impairment of venous return, and right and left heart
function without the TEE.
93313– Echocardiography, transesophageal, real time with image documentation (2D) with or without
M-mode recording; Placement of the probe only.
No modifiers are used along with CPT code 93313 for probe placement as this code does not have
separate professional and technical components.
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