CCS Prep

Cardiac Catheterization Coding: Getting to the Heart of the Matter

Print ArticleEmail Article

Cardiac catheterization/coronary angiography is considered the medical standard for evaluating ventricular function, assessing valvular heart disease and coronary artery anatomy for patients with known or suspected heart disease. Diagnostic cardiac catheterization underwent an enormous change in 2011. These changes were due to the work done by a committee that was doing a 5-year review on CPT codes that are frequently being reported together (≥ 75%) under the Medicare claims processing system. These changes encompass all procedures done, except for those patients with congenital heart disease, in a diagnostic cardiac catheterization surgical suite.

Overview of  New Cardiac Catheterization Guidelines

1. Cardiac catheterization is a diagnostic medical procedure that includes: introduction of the catheter, positioning and repositioning of the catheter, recording of intracardiac or intravascular pressure(s), the final evaluation and report.

2. The codes for the congenital cardiac catheterizations did not change in 2011. So there are now two families for cardiac catheterization, one for congenital heart disease and one set for all other conditions. 

3. Cardiac catheterizations now use one CPT code to report combinations of frequently performed services, instead of multiple codes for each part of the procedure. These procedures that were consistently performed together have now been bundled.

4. Right heart catheterization includes, catheter placement in one or more right cardiac chamber(s), obtaining blood samples for blood gas measurement and cardiac output measurement (Fick or other method).

5. Left heart catheterization includes, vascular access, catheter placement in left-sided (systemic) cardiac chamber(s), sedation and monitoring, measurement of pressures, removal of catheters, left ventriculography (if performed), coronary angiography, closure device angiography, closure device deployment and report generation.

6. Pay particular attention to the parenthetical notes under each code.

7. Please review all diagnostic catheterization codes for the symbol •, which indentifies inclusion of moderate sedation in the CPT code.

8. Do not report the diagnostic cardiac catheterization codes with 93503 flow-directed catheter (Swan-Ganz) used for monitoring purposes only.

9. Anomalous coronary arteries, such as patent foramen ovale, mitral valve prolapse and bicuspid aortic value, are to be reported with (93451-93464, 93566-93568).

Listed below are the codes that were bundled in 2011, but sometimes understanding the changes when following the CPT cardiac catheterization coding guidelines in the CPT book is a little tough. This list will give us a focal point in our discussion of the guidelines, and what they mean concerning diagnostic cardiac catheterizations today.

Code

Description

93451

RT heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed. (Do not report 93451 in conjunction with 93453, 93456, 93457, 93460, 93461)

93452

Left heart catheterization including intra-procedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed. (Do not report 93452 in conjunction with 93453, 93458-93461.)

93453

Combined right and left heart catheterization including intra-procedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed.  (Do not report 93453 with 93451, 93452, 93456-93461.)

93454

Catheter placement for coronary artery(s) for coronary angiography, including intra-procedural injection(s) for coronary angiography, imaging supervision and interpretation. (Coronary angiography without concomitant left heart catheterization)

93455

with catheter placement(s) in bypass graft(s) (internal mammary, free arterial venous grafts) including intra-procedural injection(s) for bypass graft angiography. (Indented code)

93456

with right heart catheterization. (Indented code)

93457

with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intra-procedural injection(s) for bypass graft angiography and right heart catheterization. (Indented code)

93458

with left heart catheterization including intra-procedural injection(s) for left ventriculography when performed.  (Indented code)

93459

with left heart catheterization including intra-procedural injection(s) for left ventriculography when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with by bypass graft angiography.  (Indented code)

93460

with right and left heart catheterization including intra-procedural injection(s) for left ventriculography, when performed.  (Indented code)

93461

with right and left heart catheterization including intra-procedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography.  (Indented code)

The codes 93451-93464 were created to report diagnostic cardiac catheterizations done on or after Jan. 1, 2011. The codes (93452-93461) include contrast injection(s), imaging supervision, interpretation and the report for the procedure. Left heart catheterization (93452, 93453, 93458-93461) includes intra-procedural injections for left ventricular/left atrial angiography, imaging supervision and interpretation, if those were a part of the procedure. The cardiac catheterization codes include measurements of oxygen saturation and cardiac output when done as well. 

A right heart catheterization also includes the insertion of a Swan-Ganz catheter. When coding a Swan-Ganz for monitoring purposes only use code 93503. When a Swan Ganz is inserted (usually at bedside) and left in for continuous monitoring (usually 48-72 hours), use 93503. But when the catheter(s) is placed within the right heart structures (in the cath lab), to take pressures/measurements, withdrawn when completed, use a right heart catheterization code. This code (93503) should not be used with any other right heart catheterization procedures. When coding a right heart catheterization with other procedures please make sure to read the CPT code very carefully. Make sure to use codes that have a right heart catheterization included in the code description (i.e. 93453, 93456, 93457, 93460 and 93461). (See list above.)

Use 93454 when a physician performs a diagnostic coronary angiography without a left heart catheterization. When reading the operative report this means the physician did not cross the aortic valve into the left ventricle. When the physician is using injections for guidance only during any of these procedures, do not separately code the injection.  

If a physician performs a left supravalvular ascending aortography, an add-on code should be reported (93567), as this is not included in any of the diagnostic cardiac catheterization codes. 

It is important to note that a right and left heart catheterization includes all left heart catheterization components; including the function of the mitral and aortic valves, as well as the left side aortic valve regurgitation.  It may also include angiography evaluation of coronary arteries and left ventricle for conditions, such as stenosis or occlusion, mitral valve regurgitation, stenosis, aneurysms, regurgitation or hypertrophy.

When a physician has done a right and left heart catheterization with coronary angiography, refer to 93460, but if a bypass graft angiography was done as well then look to code 93461.

There are also several add-on codes that can be used in conjunction with codes 93452, 93453, 93458-93461. These add-on codes represent different approaches, pharmacologic agent administration (nitric oxide, nitroprusside, dobutamine, milrinone, etc.) and exercise studies done before or after a cardiac catheterization procedure.

The codes 93451-93461do not include contrast injections, imaging S&I and report for imaging that is separately identifiable by a specific add-on procedure code (i.e. 93566, 93567 or 93568). These separate add-on codes can be identified in the "Table of Catheterization Codes" found on page 493-495 of the CPT 2012 Book

The most important thing a coder can do to improve her coding knowledge about these complex CPT procedural codes is to carefully read and review the CPT 2012 Book. Read the most current introductory language, guidelines and parenthetical instruction in each section and subsection.  It is also of extreme importance to read the description of each CPT code. And by using the physician's documentation, check off what has been included, and not included, in the code to determine which codes are applicable.  The CPT "Table of Catheterization Codes" can be of additional assistance in determining codes that can be used in conjunction with each other when supporting clinical documentation is available.

New 2011 Cardiac

Catheterization Codes

2010 Cardiac Catheterization

Combinations (Deleted)(What you used to use)

93451:

93501;

93452:

93510+93543+93555;

93453:

93526+93543+93555

93454:

93508+93545+93556;

93455:

93508+93539+93540+93545+93556;

93456:

93508+93501+93545+93556;

93457:

93508+93501+93539+93540+93545+93556;

93458:

93510+93543+93545+93555+93556;

93459:

93510+93539+93540+93543+93545+93555+93556;

93460:

93526+93543+93545+93555+93556;

93461:

93526+93539+93540+93543+93545+93555+93556

New Add-On Codes

2010 Cardiac Catheterization Combinations (Deleted)

+93462

 

+93463

 

+93464

 

+93563

93545+93556;

+93564:

93540+93556;

+93565

93543+93555;

+93566

93542+93555;

+93567

93544+93556;

+93568:

93541+93556;

 

New 2011 Cardiac

Catheterization Codes

2010 Cardiac Catheterization

Combinations (Deleted)

93451:

93501;

93452:

93510+93543+93555;

93453:

93526+93543+93555

93454:

93508+93545+93556;

93455:

93508+93539+93540+93545+93556;

93456:

93508+93501+93545+93556;

93457:

93508+93501+93539+93540+93545+93556;

93458:

93510+93543+93545+93555+93556;

93459:

93510+93539+93540+93543+93545+93555+93556;

93460:

93526+93543+93545+93555+93556;

93461:

93526+93539+93540+93543+93545+93555+93556

New Add-On Codes

2010 Cardiac Catheterization Combinations (Deleted)

+93462

All when performed

+93463

All when performed

+93464

All when performed

+93563

93545+93556;

+93564:

93540+93556;

+93565

93543+93555;

+93566

93542+93555;

+93567

93544+93556;

+93568:

93541+93556;

 Take the quiz on page 2.


Cardiac Catheterization Coding: Getting to the Heart of the Matter

 Next >
1 | 2

CCS Prep Archives


 
http://health-information.advanceweb.com/ICD-10-Resource-Center/default.aspx
http://shop.advanceweb.com/clearance.html