Every now and then, it’s okay to add some extras on to your plate, rather than sticking with the usual base and bland fare. And the same can be said for those anesthesiologists who perform transesophageal echocardiography, or TEE, services.
Beyond the Basics
Most of our readers are familiar with the basic diagnostic TEE services. They consist of diagnostic TEE probe placement (93313), diagnostic TEE interpretation (93314), and diagnostic TEE probe placement AND interpretation (93312).
But beyond these basics, there are a couple of supplemental services that can also be billed. Known as TEE modalities, they include Doppler-related services that are reflected on the claim form by add-on codes. These codes, listed in addition to the primary TEE service code, tell the payer that you’ve added a bit more to the plate.
A Recent Wrinkle
For years, all that was necessary to bill these add-on codes was to simply list the particular Doppler-related service you performed on the anesthesia record and/or TEE report. But, now, we have more specified guidance on how to appropriately document these services.
In the March 2026 edition of the CPT Assistant—a coding guide published by the American Medical Association (AMA)—there appeared an article in the Cardiovascular section that contained the following question and answer:
Question: When would it be appropriate to report add-on codes 93320 and 93325 with echocardiography procedures, and what documentation would be required?
Answer: Code 93320, Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); complete, is used to report Doppler echocardiography (pulsed wave and/or continuous wave with spectral display) performed in addition to real-time and M-mode echocardiographic imaging to evaluate and quantify the presence, direction, and velocity of blood flow. Code 93325, Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography), may be reported if color flow velocity mapping is performed in addition to gray-scale Doppler imaging or other echocardiography.
Alright, so we have the Doppler add-on codes defined. But what about the documentation requirements? Here’s what the CPT Assistant article had to say on that score:
The report must specifically indicate that flow velocity mapping was performed, eg, recording peak systolic flow velocity (cm/sec) through the aortic valve. If a report does not include this type of velocity measurement, it would not be appropriate to report code 93325. For transesophageal echocardiography, if Doppler (pulsed wave and/or continuous wave with spectral display) is performed, but color flow velocity mapping is not performed, it may be appropriate to report 93312, Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report, along with the add-on code 93320.
Summing It Up
As many of our readers know, the AMA publishes the CPT coding manual. Again, the CPT Assistant is its supplemental source to help providers, coders and billers better understand and implement appropriate claim submission. Most payers recognize the AMA’s authority when it comes to correct coding. So, when the AMA speaks, payers listen—which is why it’s important for providers to understand and abide by this new documentation standard concerning TEE Doppler services.
With that understood, here are the takeaways from the CPT Assistant article:
- It is no longer enough to simply list the Doppler service on the medical record or check off the service on a drop-down EMR menu.
- The provider must document velocity measurements, such as peak systolic velocity for color flow (CPT 93325).
- Based on the definitional portion of the CPT Assistant answer, providers would also do well to include in their documentation an evaluation and quantification of the presence, direction and velocity of blood flow for spectral Doppler (CPT 93320).
Without these additional data points added to the provider’s documentation, the Doppler service may be deemed unsupported and thereby rendered non-reimbursable. Accordingly, we recommend that providers who perform these services begin incorporating the required documentation as soon as possible so that, as payers update their policies to reflect the AMA’s guidance, anesthesia providers will already be well positioned for compliance and reimbursement.