Anesthesia Coding Alert

Your doc needs to do this to get paid on more than CS cath placement .

Quick -- look up the CPT code for coronary sinus (CS) catheter placement used during cardiac surgery. No luck? Then an unlisted code reporting is in your future.Here are the whys and hows on this unique procedure.

Myth 1: Code 93508 Applies to CS Cath Fact: Code 93508 (Catheter placement in coronary artery[s], arterial coronary conduit[s], and/or venous coronary bypass graft[s] for coronary angiography without concomitant left heart catheterization) does not apply to coronary sinus catheter placement, even if you append modifier 52 (Reduced services). In addition, the 936xx range of codes (those for EP studies) are inappropriate.Instead, an unlisted code is your best choice.

Anesthesiologists insert coronary sinus catheters for minimally invasive heart valve surgery, says Farhan Sheikh, MD, professor of anesthesiology and director of cardiac anesthesia at Albany Medical Center. The coronary sinus is inserted with a catheter to deliver retrograde cardioplegia solution with TEE guidance, not for monitoring or angiography purposes.

Coronary sinus pressure is monitored when the retrograde cardioplegia solution is being injected into it, but not for any other reason. Although many centers still perform the procedure, there are now less invasive means to accomplish the same patient safety goals.

Myth 2: Cath Intro Is Way to Go

An ASA teleconference in Nov. of 2008 recommended 36013 (Introduction of catheter, right heart or main pulmonary artery) for this CS cath placement. Joanne Mehmert, CPC, an independent consultant from Kansas City, Mo., disagrees, saying that currently, no CPT code describes placement of a coronary sinus catheter used during surgery.

Fact: Code 93799 (Unlisted cardiovascular service or procedure) is the best code to use for coronary sinus catheter placement for all uses except left ventricular pacing, according to CPT Assistant (April 2009). Following electronic submission of the claim, send in supporting documentation such as a procedure report describing of the procedures need and the services necessary time, effort, and equipment. In your cover letter, include a CPT reference code, like 36013, to help the insurer value the unlisted procedure code. Explain that the cath introduction procedure has similar work, malpractice risk, and practice expense as the procedure that the unlisted procedure code represents.

Myth 3: You Cant Capture Guidance

Your anesthesiologist might have to add services to ensure patient safety during CS cath placement. With proper documentation, you might get paid for guidance and more.

Doctors reporting in the medical journal Chest concluded that placement of a CS catheter can cause minor myocardial damage in about 9 percent of patients. Such damage may not be clinically evident, and only observed after thoracotomy.

CS oxygen saturation, CS flow, distal tip pressure, and fluoroscopy are reliable tools to assess a safe and correct positioning of the CS catheter, the authors say. To get paid on these items, make sure your physicians documents are crystal clear on every aspect of the placement he participated in.