93312

Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report

Transesophageal echocardiography (TEE) represented by CPT 93312 is a sophisticated cardiac imaging procedure that utilizes a specialized endoscope-like probe equipped with an ultrasound transducer at its tip. This probe is inserted into the patient's esophagus, positioning the transducer in close proximity to the posterior aspect of the heart. Because the esophagus sits directly behind the heart, TEE provides high-resolution images of cardiac structures without the interference of ribs, chest wall tissues, or air-filled lungs, which often limit the quality of conventional transthoracic echocardiography (TTE). This comprehensive code encompasses three distinct phases of the service: the initial placement of the probe into the esophagus and/or stomach, the real-time acquisition of two-dimensional (2D) images and potentially M-mode recordings, and the final interpretation of the acquired data by a physician followed by the generation of a formal written report. During the procedure, the cardiologist manipulates the probe by advancing, withdrawing, rotating, and flexing the tip to obtain a standardized set of views, including mid-esophageal, transgastric, and upper esophageal planes. These views allow for meticulous inspection of the cardiac chambers, particularly the left atrium and its appendage, the interatrial septum, the four cardiac valves, and the thoracic aorta. TEE is particularly superior for identifying small vegetations associated with endocarditis, detecting intracardiac thrombi before cardioversion or catheter ablation, and evaluating the severity of valvular regurgitation or stenosis. It is also an essential tool for intraoperative monitoring during cardiac surgery and guiding structural heart interventions, such as transcatheter valve replacements or septal defect closures. The procedure typically requires conscious sedation or general anesthesia, given the invasive nature of the probe insertion and the need for patient comfort and cooperation.

Clinical Indications

  • Evaluation of embolic source in patients with stroke or systemic embolism
  • Diagnosis and management of infective endocarditis
  • Evaluation of prosthetic heart valve dysfunction
  • Assessment of mitral valve disease prior to surgical repair or replacement
  • Screening for left atrial thrombus prior to cardioversion or atrial fibrillation ablation
  • Evaluation of suspected aortic dissection, aneurysm, or injury
  • Intraoperative monitoring of cardiac function during non-cardiac or cardiac surgery
  • Guidance for percutaneous structural heart interventions
  • Evaluation of congenital heart disease when TTE is non-diagnostic
  • Assessment of critically ill patients with unexplained hemodynamic instability

Procedure Steps

  1. Obtain informed consent and perform pre-procedural assessment including airway evaluation.
  2. Administer local oropharyngeal anesthesia and intravenous conscious sedation or general anesthesia.
  3. Insert the transesophageal probe through the mouth and into the esophagus using a guided or blind technique.
  4. Position the probe at various levels (mid-esophageal, transgastric, and upper esophageal) to visualize cardiac structures.
  5. Perform real-time two-dimensional (2D) imaging to assess chambers, valves, and the aorta.
  6. Utilize M-mode recording as necessary to evaluate specific structural dimensions or motion.
  7. Systematically sweep through standard views to document findings and investigate clinical concerns.
  8. Withdraw the probe carefully and monitor the patient for post-sedation recovery.
  9. Analyze the captured images and cinematic loops for structural and functional abnormalities.
  10. Prepare a comprehensive written report detailing findings, interpretation, and clinical recommendations.

Coding Guidelines

  • CPT 93312 is a 'global' code including probe placement, image acquisition, and interpretation; do not report 93313 or 93314 separately for the same session.
  • To report only the physician's interpretation and report (e.g., when the probe is placed by another specialist in a facility setting), append modifier 26 or use code 93314.
  • If only the probe placement is performed by the physician, report 93313.
  • Spectral Doppler (93320 or 93321) and color flow Doppler (93325) should be reported separately as they are not included in the base TEE code.
  • For transesophageal echocardiography for congenital heart disease, use codes 93315-93317 instead of 93312.
  • Sedation services should be coded according to the CPT guidelines for moderate sedation (99151-99153) if not included in the facility fee or if performed by the same physician.
  • In the intraoperative setting, if the TEE is performed for monitoring purposes rather than diagnostic, different rules or codes may apply depending on the payer.

Associated ICD-10 Codes