Cardiology Coding Alert

Question:  I'm reporting a right iliofemoral vein puncture for right heart catheterization with thermodilution and Fick cardiac output measurements, saturation run, performed at a hospital. Should I report the puncture plus 93451, 93503, 93561, and 93562?

Codify Member

Answer: For the services you describe, you should report only 93451 (Right heart catheterization including measurement[s] of oxygen saturation and cardiac output, when performed). You should append modifier 26 (Professional component) to indicate you're reporting only the physician's services. The hospital will claim the technical component.

Rationale: New-for-2011 code 93451 states that it represents right heart catheterization, and if the physician measures oxygen saturation or cardiac output, those services are included in the code, too.

CPT® guidelines tell you that cardiac catheterization "includes introduction, positioning and repositioning, when necessary, of catheter(s), within the vascular system, recording of intracardiac and/or intravascular pressure(s), and final evaluation and report of procedure."

The guidelines go on to instruct that 93451 includes roadmapping (angiography) the physician uses to "place the catheters, including any injections and imaging supervision, interpretation, and report."

The official rules also state you should not report 93503 (Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes) with other diagnostic cardiac cath codes.

Additionally, a parenthetical note with 93561 (Indicator dilution studies such as dye or thermal dilution, including arterial and/or venous catheterization; with cardiac output measurement [separate procedure]) and 93562 (...subsequent measurement of cardiac output) tells you not to report those codes with the cardiac catheterization codes.