93312 or 93314 The TEE coding challenge - By: Julia Rose

The TEE challenge: attend anesthesia coding conferences to stay compliant with every updates.

The most common problem in anesthesia coding related to billing and in obtaining reimbursement for transesophageal echocardiography or TEE is to find out whether the procedure is for diagnostic or monitoring purposes. It is often quite difficult to say whether the TEE was diagnostic or not unless the physician identifies the purpose of the study. If you want to bill for a diagnostic TEE then append a written report, otherwise it's unlikely to withstand the scrutiny of an investigation.

The CPT involves two sets of codes for diagnostic transesophageal echocardiography or TEE. For a diagnostic test, pay close attention whether the anesthesiologist places the probe, interprets and reviews the study, or provides both the services. If your anesthesiologist places the probe and does not attach a written report then use the placement-only diagnostic TEE codes. Your physician might sometimes interpret the findings while some other physician places the probe. If your anesthesiologist is the only physician who can issue a written report of the diagnostic TEE, you should code for the "image acquisition, interpretation and report" only with 93314 for real-time TEE and 93316 for TEE for congenital cardiac anomalies.

Avoid cut-short diagnosis codes in anesthesia coding and be sure your anesthesiologist is as specific as possible while reporting diagnoses attached to TEE use. Relating the TEE code to a payable ICD-9 code is merely not sufficient. The clinical signs and symptoms must also be present and documented.

Transesophageal echocardiography is never paid nor is it ever unbundled for monitoring. When TEE is used with valvular repair or in dissection, your anesthesiologist is diagnosing to check if the surgery fixed the lesion. Then your anesthesiologist is not monitoring, but implying the surgeon whether the repair has corrected the problem to an acceptable level or not. In this case, he is playing an active role in doing more than just monitoring. You can bill a reimbursable code like 93312 or 93314 on the report, but be sure you do not label this as monitoring otherwise you'll not be entitled to reimbursement.

Stay updated with CPT codes and get expert tips on anesthesia coding by attending anesthesia coding conferences. In fact, an anesthesia coding conference is taking place in Dec 2-4 in Buena Vista Palace, Orlando, FL later this year.

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