A common question received by providers is whether a Transesophageal echocardiography for guidance for transcatheter intracardiac or great vessel(s) structural intervention(s) can be coded separately when performed during an anesthesia case.
According to Chapter II Anesthesia Services, NCCI (National Correct Coding Initiative Policy Manual) for Medicare Services,this service is integral to an anesthesia service and therefore not separately billable by the anesthesia provider.
CPT's description for the procedure is as follows: "93355 Echocardiography, transesophageal (TEE) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s) (e.g.,TAVR, transcathether pulmonary valve replacement, mitral valve repair, paravalvular regurgitation repair, left atrial appendage occlusion/closure, ventricular septal defect closure) (peri-and intra-procedural)."
Included in this service are "real-time image acquisition and documentation, guidance with quantitative measurements, probe manipulation, interpretation, and report, including diagnostic transesophageal echocardiography and, when performed, administration of ultrasound contrast, Doppler, color flow, and 3D".¹
In addition, CPT states 93355 cannot be reported in conjunction with 3-D imaging, diagnostic TEE's, TEE probe placements, congenital TEE's, monitoring TEE's, and Doppler pulsed wave and/or continuous wave, and color flow velocity mapping procedure codes.² Per the American Society of Anesthesiologists (ASA), "[i]t is not appropriate to separately report spectral Doppler, color flow Doppler, 3D echocardiography, or administration of ultrasound contrast."³
The ASA also published a Statement on Transesophageal Echocardiography, amended on Oct. 28, 2015 stating "the indication for TEE is generally based on the individual patient's condition rather than the specific surgical procedure."4
It goes on to say "[p]atients undergoing these procedures have cardiovascular disease and may have co-morbidities of such severity that they are deemed too high risk for an open procedure. These patients are at increased risk for hemodynamic disturbances due to cardiovascular lesions, which include, but are not limited to, severe valvular heart disease, intracardiac defects, and aortic aneurysm. Diagnostic interpretation of the TEE data guides selection and positioning of implanted devices, determines successful deployment, and identifies complications."5
"The scope of practice includes a determination of medical necessity, identification of appropriate indications and contraindications, an understanding of the technical aspects of probe placement and manipulation, image generation, interpretation of the data generated by TEE, integration of diagnostic imaging information into the clinical decision-making process, appropriate storage of images and data, and generation of a report. Only physicians with appropriate training or comparable experience in perioperative TEE, and who have been credentialed for basic or advanced perioperative TEE, should perform perioperative TEE."6