Cardiology Coding Alert

If coding right heart catheterizations particularly procedures that include Swan-Ganz catheters sets your heart aflutter, a few minutes brushing up on the basics could be just what you need to improve your cath coding acumen. Take a look at the following right heart cath procedure and review the coding recommendations that follow, provided by our experts. 1. Procedure Overview: Get the Facts A 58-year-old male patient with myocardial infarction and cardiogenic shock received left heart catheterization, left ventriculography and selective coronary angiography through the right femoral artery in the cath lab. He had right heart catheterization through the right femoral vein with a Swan-Ganz catheter and stenting in the left anterior descending (LAD) coronary artery. He also had intra-aortic balloon catheter placement. 2. The Operative Note: Trace the Catheter Placement The physician recorded the patient's resting hemody-namics with a 7 French Swan-Ganz catheter. He completed left ventriculography and selective coronary angiography with a 6 gauge French catheter through the right femoral artery. He traversed the total occlusion of the left anterior descending coronary artery with a 0.014 ostial wire. He performed predilatation with a 3.0-mm x 15-mm Maverick balloon. Next, he deployed a 3.0-mm x 33-mm velocity stent in the left anterior descending coronary artery. The physician inserted an intra-aortic balloon catheter through the right femoral artery and initiated counterpulsation. He took hemodynamic measurements in the right atrium, which were 0 mm of mercury; the right ventricle, 13/2 mm of mercury; pulmonary capillary wedge pressure, 2 mm of mercury; pulmonary artery, 15/3 mm of mercury; the central aorta, 85/50 mm of mercury; the aortic valve, 169/82/153 mm of mercury; and the left ventricle, 85/80 mm of mercury. The procedure indicated severe three-vessel coronary artery disease and severe left ventricular dysfunction. The physician successfully completed an angioplasty of a totally occluded left anterior descending coronary artery and measured hemodynamics consistent with cardiogenic shock. 3. Coding Advice: Follow These 6 Steps 1. Before you begin assigning any codes, read the note again to determine if the physician performed the procedure for diagnostic purposes, as in this case, or for monitoring, says Carrie Robison CPC, CHCC, a cardiology coding specialist with New Bern Internal Medicine in New Bern, N.C. And don't rely on the report heading or "topic" to guide you, she says. "Headings are often misleading and can cause overpayments or underpayments."

2. Start by reporting 93526-26 (Combined right heart catheterization and retrograde left heart catheterization; professional component) for the combined right and retrograde left heart catheterization. In this instance, the physician used a Swan-Ganz catheter to perform a diagnostic right heart catheterization to assess the patient's hemodynamic status, says Happiness Miller, RN, an auditor with the cardiac catheterization lab in Central [...]