Dollars for Diagnosis: A Single-Institutional Analysis of Billing for Intraoperative Transesophageal Echocardiography Examinations

Abstract

Objectives: The authors sought to identify correctable reasons for the failed completion of required billing elements necessary for the reimbursement of services for intraoperative transesophageal echocardiography (TEE).

Design: This was a retrospective study.

Setting: This study was completed at a single institution and large academic center.

Participants: The patient population included all adult patients who underwent cardiac surgery at a single academic center over one year.

Interventions: This retrospective review of TEE documentation and billing data was performed for the all adults undergoing cardiac surgery over the course of one year.

Methods and main results: Documentation characteristics were compared between examinations that were reimbursed and those that were not. Out of 504 TEE examinations, 30% were not reimbursed. For these examinations, there was a lower compliance in the completion of minimum billing requirements, compared with those that were reimbursed; designation as "diagnostic" (29% v 93%, respectively, p < 0.0001), procedure note (70% v 99%, p < 0.0001), and procedure order (67% v 98%, p = 0.0002). The total estimated annual loss in revenue was $36,000.

Conclusions: Understanding documentation requirements for TEE is an overlooked but important part of anesthesiology practice that may lead to substantial cost savings. Completion of a procedure note, procedure order, and documentation of an examination as "diagnostic" was associated with successful billing.

Keywords: Billing; Perioperative; Quality improvement; Transesophageal echocardiography.