Cardiology Coding Alert

CPT 1999 contains a useful group of codes that can be hard to find because the names assigned to these procedures do not match the common descriptions used by physicians or their staffs, and are not indexed very well.

Most CPT catheter codesfor example, 93503 (insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes)are diagnostic. But in some procedures, catheter procedures are therapeutic. CPT 1999 lists these procedures in a different section and refers to them as transcatheters, an unfamiliar term for many that makes the codes hard to locate in the CPT index.

Terminology Confusing

The main problem with these codes is that a lot of people arent even aware they exist. When you are looking them up in CPT 1999, quite often the descriptions in the book dont match what you are looking for, says Susan Callaway-Stradley, CPC, CCS-P, senior healthcare consultant with Elliott, Davis and Co., LLP, an accounting and consulting firm in Augusta, GA.

For example, stent placements for the lower vessels and transcatheter removal of a foreign body are both difficult to find in the CPT index.

When referencing stent, CPT offers indwelling insertion ureter, placement bronchoscopy, and urethra insertion, but nothing related to cardiovascular procedures.

Using cardio or vascular also leads to a dead end in the CPT index. However, if you are lucky enough to have your physician use the words intravascular stent, CPT will lead you to the radiologic supervision code, 75960. That code references procedures 37205 through 37208.

When searching for the code for the removal of a fractured or broken catheter, the terms catheter, catheterization, foreign body, removal, and fracture all lead nowhere in the search for a correct code.

The key difference between transcatheter and typical catheter procedures is that they are treatment, not diagnostic, procedures.

Typically, interventional procedures, where the physician goes in and takes photographs of blood vessels to determine blockages or other disease processes are represented by the codes 36000-36248. But these codes are inappropriate when billing for procedures aimed at treating the problem diagnosed by the interventional procedure, in this case, the first catheter.

The problem is that because the transcatheter codes are indexed poorly, or not named in accordance with typical usage, they are difficult to find. So physicians and coders sometimes end up using the diagnostic catheter codes, unlisted codes or codes for open procedure, all of which are incorrect.

In most offices, a transcatheter stent placement is referred to as Stent to femoral artery. So some physicians search for a stent placement code that doesnt exist, instead of using the correct code (37205-37208), labeled transcatheter placement.

Inexperienced coders may have little formal training. While they are able to look up procedures in [...]