Cardiology Coding Alert

Question: How should I report an injection procedure during a heart catheterization if the patient has had a bypass?

California Subscriber

Answer: Because the patient has had a bypass, you should consider the following codes:

• 93539 -- Injection procedure during cardiac catheterization; for selective opacification of arterial conduits (e.g., internal mammary), whether native or used for bypass
• 93540 -- ... for selective opacification of aortocoronary venous bypass grafts, 1 or more coronary arteries.

For instance, if the patient had a radial graft, look to 93539. Or if the patient had a saphenous graft, consider 93540. You should report 93539-93540 in addition to other separately reportable procedures performed at the same session, such as 93510 (Left heart catheterization, retrograde, from the brachial artery, axillary artery, or femoral artery; percutaneous) if the cardiologist performed a left heart catheterization or 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) if the cardiologist does not perform a left heart catheterization.

Remember: The bypass history affects your ICD-9 coding as well. In addition to any findings (such as 414.01, Coronary atherosclerosis; of native coronary artery, 414.02, ... of autologous biological bypass graft, or 414.04, ... of artery bypass graft), include V45.81 (Other postprocedural status; aortocoronary bypass status).