Cardiology Coding Alert

Question: Which codes should I assign for right and left cardiac catheterization with native coronary arteriography, and with left and right ventriculography?

Mississippi Subscriber

Answer: You should bill for the combined right and left heart catheterization using 93526 (Combined right heart catheterization and retrograde left heart catheterization). Don't report the individual codes for right heart cath (93501, Right heart catheterization) and left heart cath (93510, Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery, percutaneous) together when your cardiologist does both in one procedure.

Remember: Before you report performance of a left heart cath (whether alone or with a right heart cath), verify that the cardiologist documented crossing over the aorta into the left ventricle. Without that step, the cardiologist hasn't performed a true left heart catheterization.

You also should code separately for dye injection into the native coronary arteries using 93545 (Injection procedure during cardiac catheterization; for selective coronary angiography [injection of radiopaque material may be by hand]).

Report 93542 (... for selective right ventricular or right atrial angiography) and 93543 (... for selective left ventricular or left atrial angiography) for injecting dye into the right and left ventricles for ventriculography. Finally, you should report 93556 (Imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; pulmonary angiography,aortography, and/or selective coronary angiography including venousbypass grafts and arterial conduits [whether native or used in bypass]) for the coronary angiography S&I, and 93555 (... ventricular and/or atrial angiography) for the ventriculography S&I.

Don't forget your modifiers: Assuming that the cardiologist completes these services in a facility or cath lab, you'll need to append modifier 26 (Professional component) to those codes that have both professional and technical components. Your coding should look like this:

• 93526-26
• 93542
• 93543
• 93545
• 93555-26
• 93556-26.