Cardiology Coding Alert

Question: On day two of thrombolytic therapy, the physician performs RHC, removes the therapeutic catheter, and re-evaluates and re-measures the pulmonary artery pressures. How should I code this?

Codify Member

Answer: Removal of the therapeutic catheter is a part of the thrombolytic therapy (37201, Transcatheter therapy, infusion for thrombolysis other than coronary), which you should report only once per field even if the catheter is in place for multiple days.

Watch for: In some cases, providers will check the catheter by angiography periodically (12 hours, 18 hours, 24 hours, etc.), only adjusting the existing catheter from point A to point B but not removing it. When this is the case, you should report 75898 (Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion) once per session when performed.

If the catheter is exchanged with a new infusion catheter and the infusion is continued, you may report 37209 (Exchange of previously placed intravascular catheter during thrombolytic therapy) and 75900 (Exchange of previously placed intravascular catheter during thrombolytic therapy with contrast monitoring, radiological supervision and interpretation) in addition to 75898, when you have supporting documentation.

For the right heart catheterization (RHC) and pulmonary artery pressures, you should report 93451 (Right heart catheterization including measurement[s] of oxygen saturation and cardiac output, when performed). CPT® guidelines state that "Right heart catheterization includes catheter placement in one or more right-sided cardiac chamber(s) or structures (i.e., the right atrium, right ventricle, pulmonary artery, pulmonary wedge), obtaining blood samples for measurement of blood gases, and cardiac output measurements (Fick or other method), when performed."