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Coding Cardiac Catheterizations

A cardiac catheterization is a diagnostic procedure where a catheter is inserted into the heart to examine heart function and detect any issues. The document discusses how cardiac catheterizations are coded, noting they were previously coded with three separate codes but are now bundled into a single code. It provides a chart showing the codes for right and left heart catheterizations, as well as add-on codes for things like injections or stress tests. Congenital cases continue to be coded separately. The document concludes by answering questions on coding two patient cases involving stents and other cardiac procedures performed during catheterizations.

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831 views4 pages

Coding Cardiac Catheterizations

A cardiac catheterization is a diagnostic procedure where a catheter is inserted into the heart to examine heart function and detect any issues. The document discusses how cardiac catheterizations are coded, noting they were previously coded with three separate codes but are now bundled into a single code. It provides a chart showing the codes for right and left heart catheterizations, as well as add-on codes for things like injections or stress tests. Congenital cases continue to be coded separately. The document concludes by answering questions on coding two patient cases involving stents and other cardiac procedures performed during catheterizations.

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Coding Cardiac Catheterizations

First of all what is it? It is a diagnostic procedure. Here are a few


great YouTube videos
1 http://youtu.be/kY5gKdFWT3k
2 http://youtu.be/sXrO52vqUQI
Prior to 2011 you needed three pieces to code a cardiac cath
1 catheterization code
2 injection (of dye) code - 1 or more
3 imaging code - 1 or more
Now we have things packaged up differently.
What you need to abstract:
1 congenital or not
2 which side of heart - right, left or both
3 any add on procedures
Being the visual learner I am I had to put this in a chart. Your
2013 CPT Manual includes a chart as well starting on page 516.
However I like looking at it based on which side of the heart is
being catheterized and narrowing it down from there.
For non-congenital things are bundled so one code represents the
catheterization, the injection and the imaging.

By Laureen Jandroep, CPC, CPC-I, CMSCS, CHCI ~ Instructor (888) 226-5799


www.CodingCertification.org [email protected]

Location

Code

Includes

Right Heart Catheterization


Default 93456

injections + imaging

With Bypass Grafts 93457

injections + imaging

Right Only - no coronary arteries 93451


Left Heart Catheterization
Default 93458

injections + imaging

With Bypass Grafts 93459

injections + imaging

Left Ventricle Only 93452

injections + imaging

Left & Right Catheterizations


Default 93460

injections + imaging

With Bypass Grafts 93461

injections + imaging

Left Ventricle Only 93453

injections + imaging

Native Only 93454

injections + imaging

Native + Bypass 93455

injections + imaging

Vessels Only

Injection Add On Codes


for selective right ventricular or right atrial 93566
angiography

*only report one of these injection


add on codes per case

for supravalvular aortography 93567


for pulmonary angiography 93568
Other Add On Codes
via a transseptal route 93462
Pharmacologic agent administration 93463
Physiologic exercise study 93464

By Laureen Jandroep, CPC, CPC-I, CMSCS, CHCI ~ Instructor (888) 226-5799


www.CodingCertification.org [email protected]

If congenital then you are going to have one code for the
catheterization (93530-93533) and contrast injection(s) are
coded separately with 93563-93568.
If diagnostic angiography is performed during the same session as
therapeutic intervention, append the -59 modifier to the S&I codes.
S&I codes are not used to report post intervention injections in the
coronary vessels to determine level of effectiveness. These
injections and S&I are included in the valuation of the intervention
codes and not reported separately.
(AMA CPT Changes 2011: An Insiders View)

I covered cardiovascular stents and other therapeutic


interventions twice before. Here are links to those video clips:
1

CPT Stents and Cardiac Cath Coding Tips- Bubble and Highlighting ...

Medical Coding Help- Cardiovascular Stents

So now for the questions:


patient #1- Dr. did 93459 and stent/ivus/lad, and descending
aortogram
patient #2 Dr. did 93459- stent/ivus/ffr/lad
Definitions:
1 93459 - see table above - left heart cath...

By Laureen Jandroep, CPC, CPC-I, CMSCS, CHCI ~ Instructor (888) 226-5799


www.CodingCertification.org [email protected]

2 LAD = left anterior descending (coronary) artery.


3 IVUS = intravascular ultrasound (allows us to see a coronary
artery from the inside-out.)
a Great explanation at Angioplasty.Org
b 92978 - Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation and/or
therapeutic intervention including imaging supervision, interpretation and report; initial vessel
(List separately in addition to code for primary procedure)

4 Stent = 92980 - Transcatheter placement of an intracoronary stent(s), percutaneous, with or


without other therapeutic intervention, any method; single vessel

5 descending aortogram - I would need to see report but I


suspect this is more to evaluate the access site and is
therefore bundled.
6 FFR - fractional flow reserve (from 2nd question)
a 93571-26 for initial vessel and 93572-26 for additional

vessel

By Laureen Jandroep, CPC, CPC-I, CMSCS, CHCI ~ Instructor (888) 226-5799


www.CodingCertification.org [email protected]

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