New TEE Requirement

Here is what I have on billing for TEE. Interpretation vs monitoring is the key:

Billing for Intraoperative TEE

Reimbursement for intraoperative TEE is dependent on third party payer contracts, whether the echocardiographer is a cardiologist or anesthesiologist, and the geographical region. Many third party payers have adopted the Center of Medicare Services (CMS) 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. 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.”

The key points for reimbursement of IOE services should include:

1. 1) Documentation that the surgeon or other physician is requesting echocardiography for a specific diagnostic reason. The medical record should indicate this request either by an order in the medical record, the operative consent form, progress notes, or at the very least within the dictated echocardiography report. It is a good practice for the patient report to indicate the medical necessity for performing the TEE and the physician who requested the IOE service. It should also be clear whether the IOE was performed for diagnostic, monitoring, or research purposes.
2. 2) A complete interpretation and report is generated by the echocardiographer. Best practices include submission of a copy of the completed, signed TEE report with the billing sheet.
3. 3) When TEE is used for monitoring by the physician who places the TEE probe and another physician provides a diagnostic exam and report, the monitoring physician only receives compensation for placement of the probe. There is no reimbursement for diagnosis when intraoperative TEE is used solely for monitoring.
   

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New TEE Requirement