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Cardiology Coding Alert

You Be the Coder:

Be Cautious When Reporting 93544

Published on Tue Jun 21, 2005

Question: How should I code all the parts of this procedure? My cardiologist performed:
 

  • left heart catheterization
     
  • left coronary angiography
     
  • left ventriculography
     
  • venous graft angiography
     
  • internal mammary and aortic arch angiography
     
  • iliac artery angiography (so the doctor can place a perclose closure device).


    Missouri Subscriber


    Answer: Assuming your cardiologist's record supports a full left heart catheterization with venous and internal mammary imaging, you should report:
     
  • 93510-26 - Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous; professional component
     
  • 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, one or more coronary arteries
     
  • 93543 - ...for selective left ventricular or left atrial angiography
     
  • 93544 - ...for aortography
     
  • 93545 - ...for selective coronary angiography (injection of radiopaque material may be by hand)
     
  • 93555-26- Imaging supervision, interpretation and report for injection procedure(s) during cardiac catheterization; ventricular and/or atrial angiography; professional component
     
  • 93556-26- ...pulmonary angiography, aortography, and/or selective coronary 
    angiography including venous bypass grafts and arterial conduits (whether native or used in bypass); professional component    .

    You should not bill for the iliac angiography when a cardiologist performs it for closure device placement. This is because the angiography conducts imaging to provide guidance for a service that is not covered/integral to the heart catheterization.

    Red flag: Similarly, you may not be able to separately report the aortic arch angiography (93544). If the cardiologist visualized the aortic arch to provide guidance for selective catheterization of the venous graft or a roadmap for the internal mammary artery, you cannot separately bill this service.

    Code 93544 represents a diagnostic study of the aortic arch. To bill 93544, you have to have medical necessity to visualize this area. Your cardiologist's report must reflect the diagnostic nature and findings of the study.

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