Cardiology Coding Alert

Hint: You must know if the native connection is normal or abnormal.

In the article, “LAA Exclusion, Coarctation of Aorta Repair, Congenital Defect Cath Codes Highlight New Year’s CPT^® Changes,” featured in Cardiology Coding Alert, Volume 24, Issue 10, you learned all about the new codes you can report for congenital heart defect caths. Along with these options, CPT^® has also added many guidelines you must follow to ensure correct coding.

Learn everything you need to know about these new codes to keep your congenital heart defect cath claims on the up and up.

Out With the Old and In With the New Cath Codes

In 2022, CPT^® deleted congenital heart cath codes 93530-93533. Instead, you will report the following new codes 93593-+93598 for congenital heart caths:

• 93593 (Right heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone; normal native connections) and 93594 (… abnormal native connections)
• 93595 (Left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone, normal or abnormal native connections).
• 93596 (Right and left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone(s); normal native connections) and 93597 (…abnormal native connections)
• +93598 (Cardiac output measurement(s), thermodilution or other indicator dilution method, performed during cardiac catheterization for the evaluation of congenital heart defects (List separately in addition to code for primary procedure)).

Note: If your cardiologist performs thermodilution cardiac assessments during right heart catheterization for congenital heart anomalies, you may separately report this service with add-on code +93598, per CPT^®.

“The new congenital heart cath codes have been badly needed for quite some time. The old codes were ambiguous and confusing, making using them cumbersome,” says Ray Cathey, PA, FAAPA, MHS, MHA, CCS-P, CMSCS, CHCI, CHCC, president of Medical Management Dimensions in Stockton. “The new codes clarify the coding, making it simpler to use. The clarification of whether the anatomy has normal or abnormal connections, whether it’s right heart, left heart or both right and left, plus the addition of allowing cardiac output measurements, has made congenital heart cath coding far easier.”

Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania, agrees that the new codes were needed. The American Academy of Cardiology (ACC), in collaboration with other cardiovascular societies, was successful in obtaining new CPT^® codes 93593-+93598, she says. “This was much needed in accordance with advances in the treatment of congenital heart defects. These are more granular code structures to accurately describe current practices.”

Carol Hodge, CPC, CPMA, CDEO, CCC, CEMC, CPB, CFPC, COBGC, senior documentation specialist at St. Joseph’s/Candler Medical Group, says that she is excited for the new congenital heart cath codes and thinks they are better at “painting the medical picture” than the previous codes were.

“The new codes are more detailed and give a better overall description of the anatomy of the patient,” Hodge adds.

Mind These Included Services

Right heart cath codes 93593, 93594, 93596, and 93597 include the cath placement in one or more right-sided cardiac chamber(s) or structures, getting the blood samples for measurement of blood gases, and Fick cardiac output measurements, when your cardiologist performs these procedures, according to the CPT^® guidelines.

Left heart cath codes 93595, 93596, and 93597 include the cath placement in a left-sided (systemic) cardiac chamber(s) — either the ventricle or atrium, per CPT^®.

Imaging guidance, which includes fluoroscopy and ultrasound guidance for vascular access and to guide cath placement for hemodynamic evaluation, is included in all the congenital heart defects cath codes, if the same provider performs it, according to CPT^®. However, injection procedures are separately reportable.

Note Importance of Normal, Abnormal Connections

When it comes to the new congenital heart defect cath codes, you must be aware of the type of native connection to choose the appropriate code.

These new codes can be used with normal native or abnormal native connections, which means blood flow pathways are evaluated, says Julie-Leah J. Harding, CPC, CPMA, CEMC, CCC, CRC, RMC, PCA, CCP, SCP-ED, CDIS, AHIMA-approved ICD-10 trainer and ambassador, and director of clinical compliance-cardiovascular surgery at Boston Children’s Hospital in Boston, Massachusetts.

“Specifically, normal connections for the pathway of blood flow are through the right and left heart chambers and great vessels,” Harding explains. “Examples of acyanotic (left to right blood flow) defects are atrial septal defect (ASD), ventricular septal defect (VSD) and/or patent ductus arteriosus (PDA).”

On the other hand, abnormal connections (right to left blood flow) are usually cyanotic and patients are commonly described as “blue,” says Robin Peterson, CPC, CPMA, manager of professional coding services, Pinnacle Integrated Coding Solutions, LLC. Examples of abnormal connections are cardiac shunts created from a prior staged surgery, aortopulmonary (AP) collateral arteries, or patients who are on extracorporeal membrane oxygenation (ECMO).

“Codes 93593-93597 are organized based on treatment of normal native connections versus abnormal native connections, so coders should refer to the new guidelines for a full discussion of normal and abnormal connections,” Falbo says.

Hodge gives examples of normal and abnormal connections: “Two examples of a normal connection would be a patent ductus arteriosus or a ventricular septal defect. Abnormal connections include double outlet right ventricle and tetralogy of Fallot with or without major aortopulmonary collateral arteries (MAPCAs), among others.”