If your anesthesiologist takes part in a cardiac surgery case, chances are he uses a pulmonary artery (or PA) catheter during the procedure. PA catheters make the list of monitoring devices you can often code separately from other services; as such, you should keep these two tips in mind for successful claims.
Focus on the correct code
Your doctor can select between several types of PA cathethers. Some PA catheters allow the anesthesiologist to temporarily pace the heart, which might be requires for patients with underlying cardiac rhythm disturbances. You might report diagnoses such as 426. x (Conduction disorders), 427.x (Cardiac dysrhythmias), or 428.x (Heart failure) in that situation. Others allow the physician to continually monitor cardiac output and/or monitor mixed venous oxygen saturation.
Coding key: Irrespective of which PA catheter the anesthesiologist selects, he places them all the same way and CPT covers all types with a single code.
Report any PA catheter insertion with 93503.
Steer clear of extra TEE coding
Anesthesiologists also make use of transesophageal echocardiography (or TEE) to help maximize a patient’s cardiac function and optimize fluid status. Your doctor might use a PA catheter and TEE during a single case; however do not automatically assume you will be paid for both lines.
Whether a payer reimburses for TEE depends partly on the TEE’s purpose and your specific payers. Remember that an an intraoperative TEE is not the same as at TEE for monitoring purposes. Ask yourself whether the anesthesiologist used TEE for additional monitoring during the case or whether he completed a diagnostic or therapeutic TEE and understand your payer. Although the ASA considers TEE an additional service that is not part of the usual anesthetic work as indications for the service is based on a patient’s individual condition, Medicare doesn’t agree.
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