Society of Cardiovascular Anesthesiologists

President's Message

Billing for TEE

In the SCA Newsletter of last August, I indicated to you that a new SCA Task Force had been appointed to focus on economic issues that are specific to cardiothoracic anesthesiology. Reimburse-ment for TEE was being denied to many of our members and it was perceived that SCA needed to explore the reasons for such denials and propose remedies, if appropriate. Under the leadership of Sol Aronson and with the help of many SCA members, the Task Force has made significant progress. The Task Force has been able to alert the leadership of both the American Society of Anesthesiologists and the American Society of Echocardiography to the unfairness of such denials. Legal representatives in the Washington offices of both societies have begun the steps that will be necessary to ensure that anesthesiologists who provide a reimbursable service like intraoperative echocardiography are indeed reimbursed.

To understand the regional variations in reimbursement for intraoperative echocardiography, it is necessary to explore how Medicare reimbursement is implemented. The Health Care Finance Administration (HCFA) has responsibility for managing the Medicare budget and for developing and implementing national policies concerning utilization and reimbursement. HCFA has contracted with commercial insurance companies to manage Medicare services on a regional basis. Twenty-two regional carriers cover the 50 states and Puerto Rico. Local carriers must enforce the national policies promulgated by HCFA, but have authority to implement local policies (Local Medical Review Policies: LRMP) when no national policy exists. At present, there is no national policy for intraoperative echocardiography, which explains the regional variations in reimbursement.

In 1996, HCFA implemented a Correct Coding Initiative (CCI) whereby certain codes became bundled. The CPT codes that are utilized for intraoperative echocardio-graphy (93312-93314) have been bundled for most anesthetic care procedures. The bundling is not absolute, however, and with the use of a modifier, services can be unbundled. The modifier consists of a 2 digit number (-59) that is attached to the CPT code to indicate a separate procedure. The separate procedure modifier indicates that a certain procedure or service may be "unrelated or distinct from other procedure(s)/service(s) provided at that time". Since no national policy existed concerning the use of this modifier for intraoperative echocardiography, local carriers had the discretion to develop LRMP resulting in reimbursement in some regions and denials in others. The major thrust of the SCA Task Force on Economics has been to convince the local carriers that intraoperative echocardiography is indeed a separate and distinct procedure from the administration of an anesthetic. They have made enormous progress and deserve the gratitude of every SCA member. If you have been successful in dealing with this issue at the local level, the Task Force welcomes your assistance.

Comments or suggestions on this topic can be communicated to me at sca@societyhq.com or at dthys@slrhc.org. After editorial review by the Newsletter Committee, they will be published.

Daniel M. Thys, MD, FACC
President, SCA