Get to the heart of cardiac catheterization coding

Cardiac catheterization is a common procedure performed to study cardiac function and anatomy and to determine if a patient is a candidate for intervention. The AMA revised the cardiac catheterization codes in 2011.

“Those codes are meant to represent not just a small part of the intervention, but the entire procedure—the specific intervention, accessing the vessel, the closure, the catheterization, the supervision, and interpretation [S&I],” says Jillian Harrington, MHA, CPC, CPC-P, CPC-I, CCS-P, MHP, president and CEO of ComplyCode in Binghamton, NY.

The new codes contain basically the same information as the old codes, but instead of having separate codes for components of the procedure, coders will now use one inclusive code, Harrington says.
The codes assigned to report cardiac catheterization procedures are separated into two types:

  • Cardiac catheterization for congenital anomalies
  • All other heart-related situations

Diagnostic cardiac catheterization for congenital conditions
If a patient has a congenital heart condition and undergoes a cardiac catheterization, coders would look to CPT® codes 93530–93533, says Terry Fletcher, CPC, CCC, CEMS, CCS?P, CCS, CMSCS, CMC, president/CEO of Terry Fletcher Consulting, Inc., in Laguna Beach, Calif.

Those codes reflect an increasing complexity of work performed by the physician. CPT code 93530 is simply a right heart catheterization for congenital cardiac abnormalities. But by the time coders get to 93533, the physician has performed not only a right heart catheterization, but a transseptal left heart catheterization though an existing septal opening. The physician sometimes also performs a retrograde left heart catheterization. All of that work is reflected in CPT code 93533.

If the physician uses contrast injections with the cardiac catheterization for congenital conditions, coders should report the appropriate add-on code from 93563–93568.

Cardiac catheterization procedures for non-congenital conditions
Cardiac catheterization procedures include measurements of oxygen saturation and cardiac output when performed. A right heart catheterization also includes the placement of a Swan-Ganz catheter.

Coders should not report 93503 (insertion and placement of flow-directed catheter (e.g., Swan- Ganz) for monitoring purposes) with any right heart catheterization procedure, Fletcher says. Coders should only report 93503 when the Swan-Ganz is placed for monitoring purposes only.

When a physician performs a diagnostic coronary angiography without a left heart catheterization —meaning the physician did not cross the aortic valve into the left ventricle—report CPT code 93454. If the physician performed injections for guidance only during the procedure, do not separately code the injection, Fletcher says.

When a physician performs a diagnostic coronary artery and bypass angiography without a left heart catheterization, report 93455. Again, do not code injections for guidance only.

A left heart catheterization includes vascular access, sedation and monitoring, inserton and positioning of the left heart catheter, measurement of pressures, removal of catheter(s), left ventriculography (when performed), coronary angiography, closure device angiography, closure device deployment, and report generation, Fletcher says.

If the provider also performs supravalvlar ascending aortography, be sure to report add-on code 93567, Fletcher adds.

Report code93459 f the physician performs a left heart catheterization (with or without a left ventriculography), coronary angiography, and bypass graft, angiography. 

A right and left heart catheterization includes all left heart catheterization elements, including function of the mitral and aortic valves and left side aortic valve regurgitation, and may include angiography evaluation of coronary arteries and the left ventricle for disease such as stenosis or occlusion, mitral valve stenosis or regurgitation, ventricular hypertrophy, or aneurysm, Fletcher says.

The right heart catheterization evaluates the tricuspid and pulmonary valve function, measures pressures of the right atrium and ventricle, pulmonary artery, pulmonary valve stenosis, tricuspid valve stenosis, atrial and ventricular septal defects, she adds.

When a provider performs a right and left cardiac catheterization, coders should report 93453. This code includes vascular access, sedation and monitoring, insertion and positioning of the left heart catheter, measurement of pressures, catheter(s) removal, left ventriculography (when performed), closure device angiography, closure device deployment, and report generation.

For right and left heart catheterization with coronary angiography, reference 93460, Fletcher says. For right and left heart catheterization with coronary and bypass graft angiography, refer to code 93461.

Physicians can also perform a left heart catheterization using a transapical puncture or a transseptal approach through an intact septum. Coders should report add-on code 93462 with codes 93452, 93453, 93458–93461 when physicians perform and document this approach, Fletcher says.

Cardiac catheterization and imaging
Cardiac catheterization codes 93451–93461 include all of the mapping angiography the physician performs in order to place the catheters, including any injections, imaging S&I, and report. These codes do not include contrast injections and imaging S&I, and report for imaging that is separately identifiable by a specific procedure code. Code 93451 does not include any contrast injections or imagining S&I.

Cardiac catheterization codes 93452–93461 include contrast injections, imaging S&I, and a report on the imaging that is typically performed. Left heart catheterization codes 93452–93453 and 93458–93461 include intraprocedural injections for left ventricular or left atrial angiography, and imaging S&I, when performed. For coronary catheter placement, codes 93454–93461 include intraprocedural injections for coronary angioplasty and imaging S&I. 

If the provider performs right ventricular or right atrial angiography with a catheterization procedure, report add-on code 93566, Fletcher says.

When the provider performs supravalvlar ascending aortography with a right cardiac catheteriza¬tion, coders should also report add-on injection procedure CPT code 93567. Coders should report add-on injection CPT code 93578 when a provider performs pulmonary angiography with right heart catheterization. Coders can report these injections together when appropriate. Make sure the provider has documented all of the procedures performed to justify coding.

Codes 93566–93568 are not linked to any specific cardiac catheterization procedures, Fletcher says.  Coders should assign them with both congenital and non-congenital cardiac catheterization procedures, when performed.

E-mail your questions to Senior Managing Editor Michelle A. Leppert, CPC-A, at mleppert@hcpro.com.
 

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