What do you know about CPT code 93312? This important cardiology code covers a special type of echocardiography. Need some context? A transesophageal echocardiography (TEE) is essential for diagnosing several heart conditions, including blood clots, valve disease, and infections. Hence, healthcare providers perform 1.7 million TEE procedures annually in the U.S.
So, we can safely assume that the procedure itself is not a problem for many professionals. However, many providers often use incorrect modifiers or fail to document the service. Hence, they encounter reimbursement issues. To minimize such problems, we have discussed the 93312 CPT code in detail. Let’s get started with a simplified description!
CPT Code 93312 – Description
CPT code 93312 refers to a transesophageal echocardiography, also known as TEE. But what does this procedure do? It essentially helps you visualize a patient’s heart and upper aorta in more detail than a standard echocardiography. Hence, healthcare providers, usually an imaging technician or cardiologist, perform this scan to detect several diseases.
So, what happens during TEE? Usually, a technician inserts a specialized endoscope down a patient’s esophagus. The transducer (a small ultrasound device), on the tip of the endoscope, then produces sound waves. These waves, in turn, produce echoes when they bounce off different areas of the heart.
The transducer then converts these echoes into 2D images on screen, allowing healthcare providers to assess the structure and overall function of the heart. In short, 93312 covers both the technical and professional components of a TEE, such as:
- Inserting a probe
- Capturing 2D images of the heart
- Interpretation
- Written report
Scenarios Where CPT Code 93312 is Applicable
Were you already familiar with the official description? Don’t worry! The following scenarios may help you understand CPT code 93312 better.
Transesophageal Echocardiography to Diagnose Arterial Thrombosis
Although blood clots in the heart are not common, they are a frequent cause of heart attacks. In fact, arterial thrombosis is a significant concern in the U.S., mainly affecting those with underlying medical conditions, such as diabetes or coronary artery disease.
Since healthcare providers perform a TEE to check for these semi-solid masses of blood cells in the heart chambers, let’s envision a similar scenario. Suppose a 52-year-old man with hypertension arrives in the emergency department after experiencing angina (chest pain or discomfort).
The healthcare provider quickly attends to him, taking his history, conducting a physical exam, and ordering imaging tests. However, the results don’t show enough details. Hence, he performs a transesophageal echocardiography to identify the root cause of the problem. The billing team then uses CPT code 93312 to bill for this scan.
Pre-Operative Transesophageal Echocardiography
Although not essentially necessary, healthcare providers often perform a transesophageal echocardiography before cardiac ablation in some cases. The primary reason? To check for blood clots in the left atrial appendage (LAA).
Let’s assume a 76-year-old woman with atrial fibrillation is scheduled for cardiac ablation. However, the healthcare provider performs a transesophageal echocardiography before the surgery. His reason? To rule out left atrial thrombus, since women over 75 years of age are at a higher risk of developing blood clots. He then uses CPT code 93312 to report this service.
TEE to Diagnose Heart Valve Disease
According to the CDC, heart valve disease is largely an unknown condition among the general population. However, it is a serious problem, affecting over 5 million people in the U.S. annually. This condition is often diagnosed with several tests, including TEE. So, for the final example, let’s consider a 73-year-old heart patient who arrives for a routine checkup.
Since this disease is often silent, let’s also assume that the patient does not have any major symptoms. However, the cardiologist immediately performs a transesophageal echocardiography after noticing a faint heart murmur during one examination. He then bills for this diagnostic test using CPT code 93312.
Applicable Modifiers for CPT Code 93312
As for the common modifiers, you can apply the following to CPT code 93312:
Modifier TC
Were you only responsible for the technical part of the transesophageal echocardiography? If you only prepared and used the equipment to obtain a patient’s heart images, use modifier TC with CPT code 93312.
Modifier 26
Did a separate healthcare provider interpret the TEE scan? In this case, append modifier 26 to CPT code 93312.
Modifier 59
Was the performed TEE distinct from other services rendered on the same day? If yes, then apply modifier 59 to CPT code 93312.
CPT Code 93312 – Billing & Reimbursement Guidelines
Follow these simple instructions to maximize TEE’s reimbursements.
Use CPT Code 93312 for Diagnostic TEE
Don’t confuse the 93312 CPT code with 93315! While the two are similar, there is a key difference. In simple terms? CPT code 93312 reports a standard diagnostic transesophageal echocardiography. On the other hand, the 93315 CPT code represents TEE specifically for evaluating congenital cardiac anomalies.
Document Medical Necessity
You must also document the clinical reason for performing TEE. This involves recording the following information:
- Patient’s symptoms (if there are any)
- Reason (comprehensive analysis, suspected disease)
- Appropriate diagnostic code (ICD-10 code)
- Detailed test report (probe placement, obtained images, and interpretation)
Use Appropriate Modifiers
As we mentioned in the description, CPT code 93312 covers both the technical and professional components of a TEE. If the test is performed by a technician and the interpretation is by a cardiologist, use modifiers TC and 26 with the code for their respective parts.
Verify Payer Policies
Finally, verify TEE’s coverage requirements with each insurer. For example, Medicare specifies that CPT code 93312 should be used when a contrast is used. Therefore, review different policies before filing a claim for this code.
Summary
We hope that you now have all the key details to code a diagnostic transesophageal echocardiography correctly. Did you miss something important? Let’s do a quick recap! CPT code 93312 specifies a diagnostic scan, TEE. It is used to visualize a patient’s heart structure and functions from within their body, specifically from the esophagus. Hence, it provides more comprehensive test results.
In this blog, we have discussed three detailed scenarios along with a simplified description so you can apply this code accurately. We have also highlighted appropriate modifiers and key guidelines for timely reimbursements.
However, if you have a poor compliance and accuracy record, we recommend working with an expert. File timely claims and meet payer requirements by choosing one of the best cardiology billing services.
