Cardiology Coding Alert

Hint: You must know if the patient had CABG to report the correct code.

If you code for catheterization procedures in your cardiology practice, you know this can be very challenging because you have codes for so many different types of situations including right caths, left caths, combo right and left caths, and cath procedures for congenital (93530-93533), as well as non-congenital services (93451-93461), just to name a few.

Recently at the 2021 HEALTHCON session “In the Cath Lab: Cardiac Catheterization and PCI Coding,” instructor Sharon Jane Oliver, CPC, CDEO, CPMA, CRC, discussed some ways you can make sure to submit clean cath claims in your office.

Read on to learn more.

Tip 1: Understand Purpose of Diagnostic Caths

“Diagnostic heart catheterizations are used to assess cardiac function and the patency of coronary arteries,” Oliver said. “Blockages in these arteries deprive the myocardium of oxygen-rich blood that it relies upon for energy and nutrients.”

Several different factors can cause blockages, and the most common is the gradual buildup of cholesterol, according to Oliver.

When your physician performs a heart catheterization, he is able to develop an optimal treatment plan for the patient, which can include medication management, percutaneous intervention, or coronary artery bypass grafting.

Tip 2: Cardiologist Performs Right Heart Cath With Other Cath Services? Do This

Right heart catheterization includes the cath placement in one or more right-sided cardiac chamber structure such as the right atrium, right ventricle, pulmonary artery, or pulmonary wedge, according to Oliver. The physician also obtains blood samples for measurements of blood gases and cardiac output measurements.

When a right heart cath is performed in conjunction with other cardiac cath services, you should report the following codes, according to Oliver:

• For non-coronary combined right and left heart cath, report 93453 (Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed)
• For right heart cath with coronary artery involvement, report 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)
• For right heart cath with coronary artery involvement with CABG, report 93457 (Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization)
• For right and left heart cath with coronary involvement, report 93460 (Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed)
• For right and left heart cath with coronary involvement with CABG, report 93461 (Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography)

Remember: You must pay attention to the history of the patient when reporting the above codes, Oliver cautions. For example, have they had a CABG? If they did, what artery was it done on?

Tip 3: Report Add-on Code +93462 for Left Cath Transapical, Transseptal Puncture

Left heart cath involves the cath placement in a left-sided (systemic) cardiac chamber(s) such as the left atrium and the left ventricle, according to Oliver. Left heart caths include left ventricular injections when performed.

“When left heart cath is performed using transapical puncture of the left ventricle of transseptal puncture of an intact septum, report +93462 (left heart cath transseptal or transapical puncture),” Oliver said.

You can report +93462 in conjunction with transcatheter pulmonary valve implantation code 33477, left heart cath code 93452, combined right and left heart cath code 93453, cath codes 93458-93461, transcatheter code 93582, or EP study codes 93653 and 93654, per CPT^® guidelines.

“The aortic valve (root) separates the left ventricle from the aorta,” Oliver said. “During most left heart caths, a cath is placed inside the left ventricle by pushing it across the aortic valve.”

Inside the left ventricle, the physician can measure the patient’s intra-cardiac blood pressure. This information will tell the physician how strong the left ventricle contracts and how effectively it relaxes.

With a left heart cath, oftentimes the physician will inject contrast material into the left ventricle so X-ray images of how the heart functions can be obtained, Oliver said. This study, called a left ventriculography, allows a calculation of the heart’s ejection fraction, which helps to identify any segments of the ventricular wall that have experienced a myocardial infarction (MI) and provides a visualization of how well the intra-cardiac valves are functioning.

Don’t miss: The term “pigtail catheter” is an indication that the physician is performing a left heart cath, Oliver adds.

Editor’s note: Want more great info like this? You can now register for the upcoming 2021 HCON regional conferences: https://www.aapc.com/medical-coding-education/conferences/. Visit www.aapc.com for more info.