2D TEE (93312) This service involves placement of the transesophageal echocardiography (TEE) probe, obtaining the appropriate images and views, and critical analysis of the data. Patients with increased risks of hemodynamic disturbances may require probe insertion and interpretation of the echocardiogram. This includes, but is not limited to, history of congestive heart failure, severe ischemic heart disease, valvular disease, aortic aneurysm, major trauma and burns. It may also be indicated in certain procedures that involve great shifts in the patient’s volume status. Such procedures may include vascular surgery, cardiac surgery, liver resection/transplantation, extensive tumor resections and radical orthopedic surgery. The use of TEE may also be indicated when central venous access is contraindicated or difficult and it is not possible to adequately assess blood loss and replacement, impairment of venous return, and right and left heart function without the TEE.
Code 59 If the TEE is performed for diagnostic purposes by the same anesthesiologist who is providing the anesthesia service, modifier 59 should be appended to the TEE code to note that it is distinct and independent from the anesthesia service.
Center for Medicare Services policy that defines 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 (e.g., determination of proper valve placement, assessment of the adequacy of valvuloplasty or revascularization, placement of shunts or other devices, assessment of vascular integrity, or detection of intravascular air). To be a covered service, TEE must include a complete interpretation/report by the performing physician.
2D congenital (93315) This service involves placement of the transesophageal probe, obtaining the appropriate images and views, and critical analysis of the data in patients with congenital cardiac anomalies. This includes, but is not limited to, congenital valve problems, such as bicuspid aortic valve, septal defects, including patent foramen ovale, and more complicated congenital heart defects. Should be used instead of 2D TEE (93312) for the cases listed in the code description.
TEE for guidance of transcatheter intracardiac (eg, TAVR, transcatheter pulmonary valve replacement, mitral valve repair, paravalvular regurgitation repair, left atrial appendage occlusion/closure, ventricular septal defect closure) or great vessel (93355) This code includes guidance, real-time image acquisition, documentation and interpretation during transcatheter intracardiac procedures.
3D rendering of TEE with image procession under concurrent supervision, not requiring image pstprocessing under concurrent supervision (76376) This code requires acquision and postprocessing of 3D datasets. Should be accompanied by a statement regarding the need of 3D imaging such as pre/post chemo, radiation or other therapy, reduced left ventricular ejection fraction, moderate or greater valve regurgitation, recent myocardial infarction, a cardiac mass either known or found as part of the exam, identified structural abnormalities as part of the exam, heart failure regardless of ejection fraction.
Limited TEE (93312-52) This code is used for exams that have been partially reduced at the discretion of the physician (TEE exams focused on answering a certain question—LAA thrombus, pericardial effusion, etc). Should be used instead of 2D TEE (93312) for limited exams.
PW/CW Doppler (93321) This code is used to evaluate blood velocity and flow patterns through various cardiac and vascular structures.
Color flow (93325) This code is used to evaluate the direction and character of blood flow through various cardiac and vascular structures.
Epiaortic Billing Codes:
Whenever the surgeon performs an epiaortic exam prior to cannulation please use codes 76998 and code 59.
93313 Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); placement of transesophageal probe only
93314 Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); image acquisition, interpretation and report only
93316 Transesophageal echocardiography for congenital cardiac anomalies;placement of transesophageal probe only
93317 Transesophageal echocardiography for congenital cardiac anomalies;image acquisition, interpretation and report only
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