Cardiology Coding Alert


Follow 4 Tips to Conquer Your Swan-Ganz Coding Challenges

Know how many access sites there are.

Your provider may place cardiac catheters for both diagnostic and interventional purposes. When it comes to diagnostic uses, the Swan-Ganz (SGC) catheter is a common example.

Make sure you heed these handy tips to keep your SGC coding on the up and up.

Tip 1: Understand What a Swan-Ganz Catheter Is

The SGC is a long, thin tube with an inflatable balloon tip on the end that helps the catheter move smoothly through the blood vessels and heart. Providers will place an introducer sheath into a major vein such as the internal jugular, subclavian, femoral, which lets the catheter enter the body more easily. The SGC is then directed by blood flow through the veins, into the right side of the heart, and then into the pulmonary arteries (PAs) that carry blood to the lungs.

The SGC has many ports, each with a specific function:

  • Putting fluid or medication into the heart.
  • Checking blood pressure in various locations.
  • Inflating a tiny balloon that helps with SGC placement in the PA.
  • Taking a blood sample from the PA.

Providers typically place an SGC in patients with certain types of severe cardiac conditions or whose cardiac function might be compromised prior to or during surgery.

Don’t miss: You might see the Swan-Ganz catheter referred to as a pulmonary artery catheter (PAC), according to Kelly D. Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPMA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Florida. You might also see the SGC described as a balloon flotation flow-directed catheter.

Tip 2: Grasp When a Provider Would Use an SGC

Providers use SGC as a diagnostic tool to monitor heart and lung function, evaluate hemodynamics, and determine the effectiveness of medications. They use the SGC to measure important indicators of cardiovascular function including central venous pressure (CVP), right atrial pressure, PA pressure, cardiac output (amount of blood ejected by the heart per minute), and venous oxyhemoglobin saturation (SvO2).

CPT®: Report 93503 (Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes) “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 CPT® guidelines. Do not report 93503 in conjunction with other diagnostic cardiac catheterization codes.

Don’t miss: Because a right heart catheterization (RHC) is performed with a SGC, often coders will be confused about whether it is a RHC or really a SGC insertion for hemodynamic monitoring. A good way for a coder to tell this is when a SGC is inserted, hemodynamics are taken, and at the end of the procedure the catheter is not removed, but left in.

“Although the hemodynamic measurements taken are the same whether a SGC or a right heart catheterization, a SGC is usually done at the bedside; hemodynamic measurements are taken, and the catheter is sutured in place,” says Robin Peterson, CPC, CPMA, manager of professional coding and compliance services, Pinnacle Enterprise Risk Consulting Services, LLC in Centennial, Colorado. “A right heart catheterization is typically performed in the cardiac catheterization lab; hemodynamic measurements are taken, and the catheter is removed from the body.”

Tip 3: Handle Multiple Catheters With Care

If your provider uses multiple catheters in the procedure, you must see which you can separately report. Documentation of other lines placed in addition to the SGC doesn’t  automatically mean you can report each line separately. One detail you must confirm is the number of access sites.

For example, central venous catheter placement (CVC) is included in the SGC fee. So if your provider places an SGC and threads it through a CVC line, the central line (36555 or 36556) is considered part of the SGC when your cardiologist places it through the same access site.

However, in some cases your provider may place an SGC to monitor cardiac output and a separate CVC line at a different location based on the need for multiple intravenous access ports. If you have clear documentation supporting the separate sites, append modifier 59 (Distinct procedural service) or XS (Separate structure …) to the central line code to override the National Correct Coding Initiative (NCCI) edit pair.

Sometimes, your provider also places an arterial line in addition to the SGC. If they document the two or all three lines, you can report both the arterial line (36620) and the SGC (93503) on your claim.

Tip 4: Mark Down Which Diagnoses Support an SGC

When it comes to ICD-10-CM codes, review the patient’s chart and medical history for potential diagnoses that would support medical necessity. Providers often use SGC for circumstances including:

  • For certain patients with acute respiratory distress syndrome (ARDS), myocardial infarction, or severe chronic heart failure
  • To diagnose right ventricular failure
  • To distinguish between pre- and post-capillary pulmonary hypertension

The following are examples of some diagnoses that will support medical necessity for an SGC: Note: This is not an exhaustive list.

  • I21.- (Acute myocardial infarction)
  • I26.- (Pulmonary embolism)
  • I50.- (Heart failure).

Other Articles in this issue of

Cardiology Coding Alert

View All