Cardiology Coding Alert

Heart catheterization coding follows two basic guidelines: knowing where the physician placed the catheter, and what injections he or she performed. Take a look at the following common catheterization coding combinations offered by coding experts to refresh your cath coding expertise:

1. Left heart catheterization with left ventriculography only. Report 93510-26 (Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous; Professional component), 93543 (Injection procedure during cardiac catheterization; for selective left ventricular or left atrial angiography) and 93555-26 (Imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; ventricular and/or atrial angiography). Only one injection code and one S&I code may be reported because the physician did not perform angiography anywhere but in the left ventricle.

2. Left heart catheterization with left ventricu-lography and angiography of the left circumflex artery (LCX), the left anteriordescending artery (LAD), and the right coronary artery (RCA). Use 93510-26, 93543, 93545, 93555-26 and 93556-26. This is a routine heart  catheterization scenario. Even though the physician obtained three angiograms for the three coronary arteries, you can report 93545 and 93556-26 only once.

3. Right heart catheterization with pulmonary angiography. Use 93501-26, 93541 (Injection procedure during cardiac catheterization ...) and 93556-26. The only injection code that applies to this catheterization is 93541. Because the cardiologist did not perform an angiography inside the heart, 93556-26 is the only S&I code that you would report.

4. Right heart catheterization combined with retrograde left heart catheterization, angiography of the internal mammary, left and right coronary artery angiography, and left and right ventriculography. Report 93526-26, 93539, 93542, 93543, 93555-26 and 93556-26. Bill a combined left and right heart cath with 93526-26. The physician performed several separately payable injection procedures both inside the heart chambers and in coronary and other nearby blood vessels, so you may bill 93555-26 and 93556-26. You may report each of the three injection codes listed only once, regardless of the number of injections the cardiologist performs in each anatomic area that the code describes.

5. Coronary angiography, LAD, LCX and RCA. Use 93508-26, 93545 and 93556-26. You should use 93508-26 when the cardiologist does not cross the aortic valve. Consequently, you cannot report codes used for injections in the heart (for example, 93543 and 93555-26) or the left heart catheterization code 93510-26.