Cardiology Coding Alert

Question: The cardiologist documented a trans-septal procedure. What can you tell me about this procedure? Does it have its own code?

Michigan Subscriber
Answer: Without seeing an operative report, it is impossible to know what the cardiologist is referring to, but he or she likely performed the procedure described by 93527 (combined right heart catheterization and transseptal left heart catheterization through intact septum [with or without retrograde left heart catheterization]), says Linda Laghab, CPC, a practice coder with Foothill Cardiology and California Heart, a 26-physician practice with offices throughout the Los Angeles area.

This procedure involves a right heart cath via the femoral, subclavian, internal jugular or antecubital vein to the right atrium. The catheter is then passed through the tricuspid valve into the right ventricle and into the pulmonary arteries. This procedure is distinguished from other combined right and left heart catheterizations in that the left heart catheterization involves puncturing the interatrial wall, or septum, to pass the catheter into the left atrium and, in some cases, through the mitral valve into the left ventricle.

Sometimes a separate left heart cath (retrograde, with a separate entry into the femoral, brachial or axillary artery that passes the aortic valve into the left ventricle) is also performed. It should not be billed separately, however, because it is included in 93527.

When billing 93527, include the appropriate injection (93539-93545) and supervision and interpretation (93555-93556) codes.