Cardiology Coding Alert

Mind your modifier 51 use with certain heart cath codes.

Cardiologists perform cardiac catheterizations on patients for both diagnostic and interventional purposes. Do you know which mistakes to avoid when reporting these procedures?

Cardiac caths explained: When the cardiologist performs a cardiac catheterization, he inserts a thin, flexible tube into an artery or vein in the patient's groin, arm, or neck. The cardiologist then threads the catheter through the patient's blood vessels to his heart.

Read on to learn which cardiac cath mistakes to watch out for in your cardiology practice.

Mistake 1: You Reported Congenital Codes for Certain Conditions

There are two code families for cardiac catheterization - one for congenital heart disease and one for all other conditions, according to the 2018 CPT^® guidelines.

Caution: Do not report the following congenital codes if the patient's only congenital anomaly is isolated patient foramen ovale (PFO), mitral valve prolapse, bicuspid aortic valve, or anomalous coronary arteries:

• 93530 (Right heart catheterization, for congenital cardiac anomalies)
• 93531 (Combined right heart catheterization and retrograde left heart catheterization, for congenital cardiac anomalies)
• 93532 (Combined right heart catheterization and transseptal left heart catheterization through intact septum with or without retrograde left heart catheterization, for congenital cardiac anomalies)
• 93533 (Combined right heart catheterization and transseptal left heart catheterization through existing septal opening, with or without retrograde left heart catheterization, for congenital cardiac anomalies).

Tip: Instead, according to the CPT^® guidelines, you should report anomalous coronary arteries, isolated patent foramen ovale, mitral valve prolapse, and bicuspid aortic valve with codes 93451 (Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed) through +93464 (Physiologic exercise study ...) and +93566 (Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective right ventricular or right atrial angiography ...) through +93568 (Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for pulmonary angiography ...).

Mistake 2: You Reported 93503 With Other Diagnostic Cardiac Cath Codes

You should not report 93503 (Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes)  in conjunction with other diagnostic cardiac catheterization codes, according to the CPT^® guidelines.

Tip: Instead, you should use 93503 "for placement of a flow directed catheter (e.g., Swan-Ganz) performed for hemodynamic monitoring purposes not in conjunction with other catheterization services," per the guidelines.

Swanz-Ganz defined: A Swan-Ganz catheter (SGC) is designed for specific hemodynamic monitoring and central access. Your provider can use the SGC to monitor pulmonary artery (PA) pressure, plus measure cardiac output and other cardiovascular functions. The catheter has multiple ports for central circulation access, including a regional anesthesia (RA) port, PA port, CVP port, and possibly the main line or "introducer."

A Swan-Ganz catheter is also known as a pulmonary artery or PA catheter, says Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Florida. If your provider documents placement of a PA catheter that you believe is reportable, you'll submit 93503.

Bonus: Swan Ganz is most commonly performed at bedside as a stand-alone procedure, according to Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC's Certified Cardiology Coder steering committee.

Mistake 3: You Appended Modifier 51 to Exempt Codes

CPT^® specifically identifies 93451, 93456 (Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization), and 93503 as modifier 51 (Multiple procedures) exempt.

Tip: Appendix E in the CPT^® manual lists the CPT^® codes that are exempt from the use of Modifier 51. Make sure to pay careful attention to these codes, which are marked with a  symbol in the code set.

Modifier 51 explained: "The function of modifier 51 is to identify the additional procedures or services being performed at the same operative session, by the same individual provider, as the primary procedure or service," says Yvonne Dillon, CPC, CEDC, director of emergency department services at Bill Dunbar and Associates, LLC, in Indianapolis.

Remember, you should never append modifier 51 to the following:

• Add-on codes, which the CPT^® manual lists in Appendix D and identifies with a + symbol in the code set
• Codes in Appendix E of the CPT^® manual
• Codes that have modifier 50 (Bilateral procedure) appended and therefore already have a fee reduction 
• E/M services
• Physical medicine and rehabilitation services
• Provision of supplies.

Don't miss: Medicare doesn't recommend reporting modifier 51 on your claims, Neighbors says. CMS processing system will append the modifier to the correct procedure code as appropriate.