HOSPITAL: E/M TEE

E/M coding and TEE Commercial insurance

• If both TEE (Transesophageal Echocardiogram) and EKG are done the same day, bill for the TEE only. Always check whether an EKG was done in conjunction with a TEE.

  • MCAL plans: Use code 93318 (Mod 26) for TEE.

    Commercial plans: Use one of these codes for TEE:

    • 93317
    • 93325
    • 93320 (All with Mod 26).

CPT Code Descriptions:

• 99469 – Initial inpatient pediatric critical care, per day, for patients 29 days through 24 months of age.
• 93318 – Echocardiography, transesophageal (TEE) for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report.
• 93320 – Doppler echocardiography, pulsed wave and/or continuous wave with spectral display.
• 93325 – Doppler echocardiography color flow velocity mapping.

Billing Compatibility:

Yes, these codes can be billed together;

Key Points to Consider:

✅ Medically Necessary and Separate Services

• 93318 must be medically necessary and not bundled into the critical care time represented by 99291.
• If the TEE is performed by the same physician providing critical care, the time spent on the TEE cannot be included in the total critical care time billed under 99291.

🔁 Modifier Use

• If applicable, use modifier 59 (Distinct Procedural Service) or modifier 25 (Significant, separately identifiable E/M service) with 99291 to show that the critical care service was separate and distinct from the echocardiography service.
  • Modifier 59 on 93318 may be needed if the insurer bundles the codes.
  • Modifier 25 on 99291 is more common when both are provided during the same encounter by the same provider.

Here’s a sample documentation blurb and modifier guide to help support billing 99469 with 93318, 93320, and 93325:

✅ Sample Documentation :

“Patient was admitted to the PICU and evaluated under critical care management for respiratory failure and hemodynamic instability. Care included continuous monitoring, ventilator management, and coordination with multispecialty teams.

Due to concerns for congenital cardiac anomalies and poor perfusion, a transesophageal echocardiogram was performed.

TEE (93318) with color flow Doppler (93325) and spectral Doppler (93320) was conducted to assess cardiac anatomy and function. This diagnostic procedure was medically necessary and separate from the critical care management.”

Modifier 76 – Repeat Procedure by Same Provider

• Sometimes — only use 76 when the exact same procedure is repeated on the same day by the same provider.
• Example: If 93318 was performed twice on the same date due to a clinical need, you'd bill the second one with 93318-26,76.

⚠️ Caution: Do not use 76 unless it’s truly a repeat of the same service — payers may flag this for review.