Cardiology Coding Alert

Guard Against 93510 Mishaps Using Documentation Clues

Here's why all is not lost even if 'crossed aortic valve' isn't in print.

Inappropriately reporting 93510 when 93508 is more appropriate can result in a $13 payback to your Medicare contractor -- and a lot of worry about whether the error will encourage auditors to delve deeper into your files.

Protect yourself: A full left heart catheterization (93510, Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous) requires the physician to cross over the aorta into the left ventricle. So you need the documentation to indicate in some way that the cardiologist crossed the aortic valve.

93510: If you see documentation of LVEDP (left ventricular end diastolic pressures), LV pressures, or an LV gram, these are hints that you should consider a left heart cath code, says Heather R. Stecker, CPC, ACSCA, compliance director and reimbursement manager for Cardiology Consultants of Philadelphia.

In fact, "for an LV gram to be performed, a left heart cath must also have been performed," she says. "A left heart cath can be performed without an LV gram," though, she warns. Physicians may opt not to perform an LV gram because they don't want to give the patients with renal issues too much dye load, for example, she says. But the physician can still take LV pressures in those cases.

93508: "If you see a case with just interpretations of the coronaries and nothing but AO (aortic) pressure, then you need to code 93508 (Catheter placement in coronary artery[s], arterial coronary conduit[s], and/or venous coronary bypass graft[s] for coronary angiography without concomitant left heart catheterization)," Stecker explains.

The cardiologist may decide not to cross the aortic valve for clinical reasons, such as if the patient has a prosthetic or severely calcified aortic valve.

Remember: Watching for these indicators is crucial because the report title may say "left heart catheterization," but the body of the report could reveal that 93508 (Medicare national rate, professional component, $235.88) is more appropriate than 93510 (Medicare national rate, professional component, $248.86).

Tip: With CMS's conversion to MACs, the new contractors will be able to see more easily whether hospital and physician claims match. So be sure to keep an eye on these tricky claims.

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