Cardiology Coding Alert

Question: Our physician did an endomyocardial biopsy. Can we submit code 93451 and 37200? If not, what is the correct code?

Alaska Subscriber

Answer: The most specific code for endomyocardial biopsy is 93505 (Endomyocardial biopsy). During this procedure, your physician will obtain heart tissue from the right ventricle for pathological examination. You submit only one unit of 93505 regardless of the number of biopsies your physician does in one encounter.

You should not submit codes 37200 (Transcatheter biopsy) or 75970 (Transcatheter biopsy, radiological supervision and interpretation) for endomyocardial biopsy. These codes are not specific for heart biopsy.

Watch the bundle in right heart catheterization: You do not submit code 93451 (Right heart catheterization including measurement[s] of oxygen saturation and cardiac output, when performed) for right heart catheterization if your physician did the catheterization to guide the biopsy procedure. You may however, submit 93451-59 (Distinct procedural service) for right heart catheterization if your physician does a complete right heart catheterization for medically necessary reasons and you have documentation in support of the same.

Bonus Reminder: Effective January 1, 2015, CMS established new requirements related to modifier 59. Four new modifiers have been created to define subsets of modifier 59. This change came about because CMS states in Transmittal 1422 that the use of modifier 59 is “associated with considerable abuse”. CMS hopes to gain a better understanding of when and why providers use modifier 59 by implementing the four new subsets.

The four new modifiers are:

• XE, Separate Encounter

             o A service that is distinct because it occurred during a separate encounter

• XS, Separate Structure

             o A service that is distinct because it was performed on a separate organ/structure

• XP, Separate Practitioner

             o A service that is distinct because it was performed by a different practitioner

• XU, Unusual Non-Overlapping Service

             o The use of a service that is distinct because it does not overlap usual components of the main service.