But is it worth it to get that piece of paper or can I just place the TEE probe in the ICU just to get fundamental pathologies ?
Outside of cardiac TEE is useful for a ton of other stuff. Pleural/cariac effusions, low ef, endocarditis, eval LAA in someone who is in rapid afib, etc.
I guess I’ll try to go for the basic certification during fellowship then
Although I suppose anything's possible, I've never heard of a state level prohibition on which physicians can and can't bill for TEE, and I find it hard to imagine that anyone is actually auditing the credentials of every single person who files for a 99312 CPT code. What the payors actually require is that the pt has an indication and one placed the probe, performed the exam, acquired images, and filed a written exam interpretation. The ability to perform TEE and the level CPT code at which it's billed is usually controlled at the hospital administration level when you are initially privileged.
www.sccm.org
I guess my goal will be to get the POCUS and TEE certifications.Although I suppose anything's possible, I've never heard of a state level prohibition on which physicians can and can't bill for TEE, and I find it hard to imagine that anyone is actually auditing the credentials of every single person who files for a 99312 CPT code. What the payors actually require is that the pt has an indication and one placed the probe, performed the exam, acquired images, and filed a written exam interpretation. The ability to perform TEE and the level CPT code at which it's billed is usually controlled at the hospital administration level when you are initially privileged.
That being said, I'd recommend any critical care fellow to take the CCEeXAM and become certified, or if your program has enough elective time for TEE and you plan to have primarily CTICU as your practice, try to get the numbers to get advanced PTE certified. I suspect that going forward, more and more hospitals are going to put restrictions on who can and can't use the following ultrasound codes:
SCCM | Ultrasonography in Critical Care
Learn about billing and coding for ultrasonography in critical care.
Please see the highlighted portion (page 7) of the attached Novitas TEE LCD. Physicians in 12 states must be NBE certified in order to bill Medicare for TEE.Although I suppose anything's possible, I've never heard of a state level prohibition on which physicians can and can't bill for TEE, and I find it hard to imagine that anyone is actually auditing the credentials of every single person who files for a 99312 CPT code. What the payors actually require is that the pt has an indication and one placed the probe, performed the exam, acquired images, and filed a written exam interpretation. The ability to perform TEE and the level CPT code at which it's billed is usually controlled at the hospital administration level when you are initially privileged.
That being said, I'd recommend any critical care fellow to take the CCEeXAM and become certified, or if your program has enough elective time for TEE and you plan to have primarily CTICU as your practice, try to get the numbers to get advanced PTE certified. I suspect that going forward, more and more hospitals are going to put restrictions on who can and can't use the following ultrasound codes:
SCCM | Ultrasonography in Critical Care
Learn about billing and coding for ultrasonography in critical care.
Here's the full language from the section for people who don't open the pdf:
Here's the full language from the section for people who don't open the pdf:
"Provider QualificationsThe accuracy of cardiac ultrasound depends on the knowledge, skill and experience of the sonographer and physician. Sonographers who perform or supervise the studies must be capable of demonstrating training and experience specific to the study performed and maintain documentation for post payment audit. Physicians who perform, supervise, and/or interpret the studies must be capable of demonstrating training and experience specific to the study performed or interpreted and maintain documentation for post payment audit. A physician or a sonographer may personally perform cardiac ultrasound procedures. When a physician employs auxiliary personnel to assist him /her in providing ultrasound procedures, the services of such personnel are considered ‘incident to’ to the physicians’ services. All guidelines set forth by CMS regarding ‘incident to’ must be met.Cardiovascular Disease/Cardiology, Cardiovascular Surgery, Anesthesia, Critical Care Medicine, and Pediatric Cardiologists are thought to have the formal training or clinical training to do these tests. Other specialties may see denials for these services. For all specialties, certification by the National Board of Echocardiography will be essential in allowing coverage for services and can be submitted in the appeals process should a denial occur."LCD - Transesophageal Echocardiography (TEE) (L35016)
Use this page to view details for the Local Coverage Determination for Transesophageal Echocardiography (TEE).www.cms.gov
It's kind of strange language where, indeed, it does sound like certification would be necessary "in allowing coverage for services," but on the other hand they make mention that folks like those trained in CCM or CV surgery have the training to do these tests.... but CV surgeons and intensivists (until recently with the CCEeXAM) never take the NBE exams, let alone become certified.
I will say that I know a few other people who are cardiac anesthesiology fellowship trained from the 2000s or 2010s but who never finished their certifying process for the NBE, and the TEE billing issue has never come up even though they're testamurs in the directory. One of the cardiologists here at my hospital who performs and reads both TTE and TEE is only a testamur of the ASCeXAM. And I live in one of the 12 states listed in the LCD and I can show you my collections for 93312 TEEs for the last few years.
Additionally, if one looks at the Intersocietal Accreditation Commission Standards & Guidelines for Echocardiography Accreditation (which any echo lab worth its salt has IAC) located here https://intersocietal.org/wp-content/uploads/2021/07/IACAdultEchocardiographyStandards2021.pdf , you'll notice that:
View attachment 354561
There is no mention of NBE certification for medical staff. Furthermore, if you scroll up from that page you'll see that there's not even an NBE certification requirement for the medical director of the echo lab.
All in all, I think the mention of certification in the LCD is mostly present to address situations where fraud or inappropriate billing is noticed through an audit, and in that case a person or facility would use certification in the appeals process to show appropriateness of the procedure/billing etc.
Do us (me) a favor and post that case in my favorite thread, “let’s do some echo” : )
forums.studentdoctor.net
exactly.
In fairness, “kissing paps” (low LVESV) can be seen for a number of reasons: low LV preload as a result of hypovolemia or increased venous compliance, low LV preload as a result of RV failure, or low afterload in the setting of vasodilatory shock, liver failure, etc. more fluid is not the treatment of choice for every case of end-systolic cavity obliteration… Of course you can sort all of these diagnoses out using TEE as well, in a matter of seconds: measure LV end diastolic diameter, assess IVS position, check LVOT VTI, etc.
