Embracing the Future of Anesthesia Coding: Human in the Loop
October 10, 2024Ancillary services can be reported separately in anesthesia, often called “flat fees.” In reality, these are surgical services reported in addition to anesthesia services. Ancillary services include postoperative pain blocks, lines, and the ultrasound guidance associated with each category and transesophageal echocardiograms (TEE).
Practices throughout the country have recently experienced the increased scrutiny payers have placed on blocks, lines, and ultrasound guidance, making it crucial to solidify your understanding and documentation practices. While TEEs have not experienced the same issues with payers, the topic is one that audits identify misunderstandings between the types of TEE services and when anesthesia providers can report them.
Understanding the different categories of TEEs in the CPT manual is key. These fall into three main types: diagnostic, which includes congenital TEEs, monitoring, and guidance.
According to NCCI Chapter 2, monitoring TEE services (93318) cannot be reported separately from anesthesia services. Monitoring TEE services cannot be divided into parts, meaning probe placement is not permissible when the indication is monitoring.
NCCI Chapter 2 supports that diagnostic TEEs, which include congenital TEEs, may be reported separately when the diagnostic criterion is met and the documentation is adequate.
When examining the 2024 CPT Professional Edition (published by the American Medical Association), you’ll notice that the codes highlighted with green in the grid below represent diagnostic TEE services. These services, which anesthesiologists most commonly perform, involve both the placement of the probe and the interpretation of the results. When both components are performed by the same provider, a single diagnostic TEE code is reported (93312, 93315). However, it’s also possible for different providers to handle different portions of the TEE service, with each billing for their specific work using the appropriate CPT code probe placement only (93313, 93316) or interpretation and report only (93314, 93317).
It’s important to note that while NCCI Chapter 2 states that guidance TEEs (93355) are bundled with anesthesia services, other resources, such as NCDs and guidelines from the American Society of Echocardiography, clarify that these may be reported separately by a different provider than the individual providing the anesthesia service.
In the next article of this series, we’ll take a deeper dive into the separation of these services, providing you with actionable insights to keep your documentation and coding both compliant and accurate.
If you have any specific questions, please send them to us at aceadmin@aceauditors.com.