# Selective coronary angiogram



## dawnhomer (Aug 13, 2013)

My Dr. indicates SELECTIVE CORONARY ANGIOGRAM, and then in the body of the cath report he indicates; left main artery, left anterior descending artery, left circumflex artery, right coronary artery.

I know that he is doing a left heart cath with VGRAM, but how do I report all the select location somehow, or are they included in the 93458?
It kind of makes sense as the 93454 code indicates "cath placement in coronary artery(s), but I don't want to miss anything.  
Is there another set of codes that I should be adding or a radiology set of codes?  Any help would be appreciated.  
Dawn: confused:


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## jewlz0879 (Aug 14, 2013)

Without seeing your report, I can't be 100% but here are my thoughts...

If he performs only selective coronary angiography, then yes, 93454-26. 

However, if he does selective coronary angio with LV gram or LEDP, then 93458. 

All those locations are included with selective angio's If you think about it, he is taking a picture of those coronary vessels, right and left. Those include RCA, LM, LAD, LC. 

I'm sure you already are aware of this, but you still code separately for:

1. left ventricular or left atrial angiography (+93565)
2. selective right ventricular or right atrial angiography (+93566)
3. supravalvular aortography (+93567)
4. pulmonary angiography (+93568)

It's wikipedia but it might help, lol. 

http://en.wikipedia.org/wiki/Coronary_catheterization


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## Jim Pawloski (Aug 14, 2013)

jewlz0879 said:


> Without seeing your report, I can't be 100% but here are my thoughts...
> 
> If he performs only selective coronary angiography, then yes, 93454-26.
> 
> ...



Hey Julie,

I agree with everything about, except for 93565.  That code is for a Congential Heart Cath, not for a normal Left Heart Cath (93458) which includes the LV gram.

Thanks,
Jim Pawloski, CIRCC


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## jewlz0879 (Aug 14, 2013)

You're so right! My bad. Thanks for catching that, Jim!


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## dawnhomer (Aug 23, 2013)

*left heart cath, Left heart vgram, select coronary angiography*

I know that I would use 93458 the main procedure code, but when he indicates "Select Coronary angiography" and then lists Left main coronary artery, left anterior descending artery, left circumflex artery, and right coronary artery,  do I bill other codes for the arteries that he lists?   So my question is, does 93458 include all the "select angiograms" that he indicates or should I be adding additional Angiography codes to the billing?  Code 36215 is not included per CCI, so would I use that code with a radiology code?  The notation with the 36000 codes make it sound like the selective coronary angio codes are to be included in the cath codes.   Help I am so confused, and don't want to miss any codes. Dawn


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## dpeoples (Aug 23, 2013)

dawnhomer said:


> I know that I would use 93458 the main procedure code, but when he indicates "Select Coronary angiography" and then lists Left main coronary artery, left anterior descending artery, left circumflex artery, and right coronary artery,  do I bill other codes for the arteries that he lists?   So my question is, does 93458 include all the "select angiograms" that he indicates or should I be adding additional Angiography codes to the billing?  Code 36215 is not included per CCI, so would I use that code with a radiology code?  The notation with the 36000 codes make it sound like the selective coronary angio codes are to be included in the cath codes.   Help I am so confused, and don't want to miss any codes. Dawn



Dawn,
The code description for 93454 (which is the primary description for codes 93455-93461 as well) states:
_"Catheter placement in coronary artery*(S)* for coronary angiography, including intraprocedural injection (*S*) for coronary angiography, imaging supervision and interpretation;"_

Don't miss that *(S*) in the description. This means you do not bill separately for each artery, the procedure includes all arteries mentioned in the code description. 

HTH


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