no you are rt no LHC is 93454 below is the Optum coders desk reference of description of procedure:
93454
The physician performs a catheter placement in one or more coronary arteries for coronary angiography, without concomitant left heart catheterization. The physician places an introducer sheath in an artery, typically the femoral artery, using percutaneous puncture. The physician advances an angiography catheter through the introducer sheath into the ascending aorta and advances it, under fluoroscopic guidance, to the opening of the coronary artery. The physician injects radiopaque contrast material through the catheter into the vessel while recording a cineangiogram. The physician removes the catheter and sheath from the femoral artery. Pressure is placed on the wound for 20 to 30 minutes to stem bleeding. This code includes imaging supervision and interpretation, as well as any required repositioning of catheters.
coding clinic 3rd quarter 2017 sorry this will be long but is a good reference
Coding and reporting of catheterizations and angiographies
From a coding perspective, the appropriate reporting of cardiac catheterization with angiography procedures can be challenging.
Coders must be aware that there are two separate groups of CPT codes for the reporting of cardiac catheterization procedures that are based on the conditions treated.
Caution must be exercised by the coder to insure appropriate reporting of the procedures performed. The groups of CPT codes are identified as follows:
•Cardiac Catheterization for Congenital heart disease (93530-93533)
•Cardiac Catheterization for All other conditions (93451-93461)
Please note: Many of the CPT codes for cardiac catheterizations and angiographies describe multiple components that are integral to the procedure process and would not be separately reported.
Let's discuss the types of cardiac catheterizations and what is considered integral to the procedural process.
Right heart catheterization
In a right heart catheterization information is obtained from the right heart chambers (ie, right atrium and right ventricle) and the tricuspid valve. This procedure process includes:
•Catheter placement in one or more right-sided cardiac chamber(s) or structures
a. right atrium
b. right ventricle
c. pulmonary artery pulmonary wedge
•Obtaining blood samples for measurement of blood gases, and
•Cardiac output measurements (ie, Swan-Ganz catheter)
Left heart catheterization
In a left heart catheterization information is obtained from the left heart chambers (ie, left atrium and left ventricle), the mitral valve, and the aortic valve. This procedure process includes:
•Catheter placement in a left-sided (systemic) cardiac chamber,
•Left ventricular injection(s) when performed
•Assessment of left ventricular function
•Assessment of outflow tract obstruction
Right and left heart catheterization
A right and left heart catheterization includes all of the elements of individual left and right heart catheterizations.
To appropriately report the services provided the coder should know based on documentation in the medical record what was performed during the procedure.
For this issue, we will focus on the coronary angiography which is often performed along with the cardiac catheterization.
Coronary angiography
When a coronary angiography is utilized with a cardiac catheterization, images of the interior coronary arteries can be captured. The procedure process involves the injection of contrast agent(s) through the catheter into the blood vessel for images of the vessel(s) to show blood flow, and blood vessels that are enlarged, obstructed, blocked, or narrowed, and to determine the location as well as the severity of disease.
Although, the cardiac catheterization procedure is performed for a diagnostic purpose, when performed in conjunction with an angiography, it is utilized to diagnose and treat diseases and abnormalities of the blood vessels, such as, atherosclerosis, blood clots, aneurysms, and coronary artery disease for detection of blockages in the coronary arteries.
Here are several services considered integral to the cardiac catheterization and angiographic procedures and are not separately reported. These services are listed as follows:
•Local anesthesia and/or sedation
•Introduction, positioning, and repositioning of catheters
•Recording of intra-cardiac and intravascular pressures
•Obtaining blood samples for blood gases
•Cardiac output measures
•Monitoring services, e.g., arterial pressures, oxygen saturation
•Vascular catheter and line removal
Because these services are inherent or integral to the procedural process, it would be inappropriate to append modifier 59, Distinct Procedural Service, to bypass coding edits. Coding guidance specifically state that modifier 59 would only be utilized to identify procedures or services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.
The documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual.
CPT codes for cardiac catheterization include all roadmapping angiography for placement of the catheters, including any injections and imaging supervision and interpretation.
Additionally, with regard to right heart catheterizations, instructional notes listed under the CPT angiography codes 93566 and 93568, specifically state that it would be appropriate to separately report these codes in conjunction with CPT code 93456, Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injections(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization.
Let's take a look at a Q&A below:
QUESTION 1
A right heart catheterization is performed with a coronary angiography in the cardiac catheterization lab and the patient is taken to the interventional radiology suite where a pulmonary arteriogram and nitric oxide challenge, is performed through the same access site, is it appropriate to use the add-on CPT code 93568 for the pulmonary angiography with the CPT code for the cardiac catheterization?
ANSWER
Yes, it would be appropriate to report CPT code 93568, Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for pulmonary angiography, for the pulmonary angiography performed, with CPT code 93456, Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injections(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization, for the right heart catheterization.
In addition, CPT code 93463, Pharmacologic agent administration (e.g., inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrionone, or other agent) including assessing hemodynamic measurements before, during, after, and repeat pharmacologic agent administration, when performed, would be reported for the nitric oxide challenge.
Instructional notes listed under CPT codes 93463 and 93568, specifically state that it is appropriate to report these CPT codes in conjunction with CPT code 93456.
