# 93580 ASD Closure w/ Pulm Angio



## mashtoncason@gmail.com (Oct 29, 2014)

I am probably making this more complicated then it needs to be but I am trying to code a right and left (retrograde) heart cath with congenital anomalies that includes an ASD closure with both coronary and pulmonary angios S&I. 

Per the CPT book I have coded 93580 for the ASD closure and used add on code 93662 for the intracardiac echo. 

The CPT book states that 93580 includes a RHC but nothing of the LHC is mentioned. Can I also code 93454 with modifier 59 for the LHC and coronary angio S&I? Is there another code I can use to bill for the pulmonary angio? The only pulmonary angio code I know of is the 93568 which is an add on code that cannot be paired with the 93454 or the 93580. Is the pulmonary angio included in the 93580? 

Please help..


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## Amy Pritchett (Oct 29, 2014)

First, 
There are multiple options to cross the defect, depending on the anatomy of the defect. A ventricular septal defect or (VSD) is a defect in the ventricular septum (wall that divides the left and right ventricles of the heart). The physician is closing the VSD through the catheter. 

Also,
NCCI edits state that the RT/LT cath cannot be coded together under any circumstance. Therefore, this should be coded:

93581
93568
93662
and the catheterization is inclusive of the VSD.

Hope this helps


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## theresa.dix@tennova.com (Oct 30, 2014)

mashtoncason@gmail.com said:


> I am probably making this more complicated then it needs to be but I am trying to code a right and left (retrograde) heart cath with congenital anomalies that includes an ASD closure with both coronary and pulmonary angios S&I.
> 
> Per the CPT book I have coded 93580 for the ASD closure and used add on code 93662 for the intracardiac echo.
> 
> ...



The r & lhc are included in cpt closure code. CPT tells us that right under the code 93580 and 93581. In this case since you have said it is a ASD I would use 93580. 93581 is for VSD.


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## mashtoncason@gmail.com (Nov 5, 2014)

theresa.dix@ethc.com said:


> The r & lhc are included in cpt closure code. CPT tells us that right under the code 93580 and 93581. In this case since you have said it is a ASD I would use 93580. 93581 is for VSD.



Thank you for your help!! 

I agree that I should use the 93580 for ASD and that the CPT tells us right there that the cath is included but it only states "Percutaneous transcatheter closure of atrial septal defect includes a right heart catheterization procedure." 

It does not state that it includes a left heart cath, coronary angio, or pulmonary angio. 93454 "Limited left heart cath w/ coronary angio, S&I" is not listed as a CCI problem with 93580; so I billed the two of them together. However, I cannot find documentation that states the pulmonary angio is included but CPT/ CCI does not allow the pulmonary angio add on code to be used in conjunction with 93454 or 93580 so I left it off.


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## theresa.dix@tennova.com (Nov 6, 2014)

mashtoncason@gmail.com said:


> Thank you for your help!!
> 
> I agree that I should use the 93580 for ASD and that the CPT tells us right there that the cath is included but it only states "Percutaneous transcatheter closure of atrial septal defect includes a right heart catheterization procedure."
> 
> It does not state that it includes a left heart cath, coronary angio, or pulmonary angio. 93454 "Limited left heart cath w/ coronary angio, S&I" is not listed as a CCI problem with 93580; so I billed the two of them together. However, I cannot find documentation that states the pulmonary angio is included but CPT/ CCI does not allow the pulmonary angio add on code to be used in conjunction with 93454 or 93580 so I left it off.



Hmm let me check that out again!

ok I have looked at this. It does says 93580 includes right heart cath but keep reading. It also says codes 93455 thru 93461 should NOT be reported in addition  with code 93580. R&LHC is code 93460( that is what you said the doc performed). It comes between 93455 and 93461. So you cannot unbundle it up and say hmm, I guess I will not code the right heart cath part of the procedure and just use the cath placement in the coronaries portion of the procedure because that is not listed. take a look at the descriptions of the codes 93454 is not a limited left heart cath.


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