Billing and Coding: Transesophageal Echocardiography (TEE)

This policy provides billing, coding, and documentation guidance for Transesophageal Echocardiography (TEE) claims: claims must include a valid ICD-10-CM diagnosis and, when applicable, the referring/ordering physician's name and NPI. Use appropriate ABN modifiers (-GA, -GX, -GZ, -GY) per reason for anticipated denial and obtain/sign Form CMS-R-131 when required; documentation must include assessment, relevant history, test results, and signed visit/operative reports. Claims are subject to NCCI and OPPS edits, Part A MAC auto-denial rules for certain modifiers, and providers must notify beneficiaries in writing when services may not be covered (with specified exceptions).

"A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act."

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