# Definition of a Left Heart Cath



## jtuominen (Apr 2, 2009)

Hi again--

A few coders in my department have been debating the defintion of a left heart cath. A few of them say that they would only code a 93510/37.22 when the dictation states that a left ventriculogram (93543, 93555/ 88.53)was performed. For example, if documentation states a left ventriculogram was not performed due to dye load they would not code 93543, 93555/88.53 AND forgoe coding 93510/37.22  I have always believed these two procedures are independent of one another, and all you need to code a 93510/37.22 is documentation that the catheter entered the left ventricle. If documentation is a little vague I try to see if I can find something that tells me a pullback pressure was recorded from the LV to AO. Is this a good piece of information to delinate when a 93510/37.22 is performed? What is the consensus out there?


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## ejkam3 (Apr 2, 2009)

In the cardiology office I work in, we stand by the billing of the 93510 if LV pressures are recorded and the physician makes mention of crossing the aortic valve.  If no dye is injected, we leave off the 93555, 93543.  For instance, if the doc performs a coronary angio, crosses the ao valve, and records lv pressures only, we would code 93510, 93556, & 93545.  A left heart cath, 93510, according to the CPT book, occurs when the catheter crosses into the left ventricle.  It doesn't say anything about injecting.  The 93555, 93543 are for "injection procedures performed in conjunction with cardiac catheterization" and S&I.  Hope this helps.


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## deeva456 (Apr 3, 2009)

you are both correct.  the catheter must cross the aortic valve into the left ventricle to be a left heart cath regardless if the ventriculography (93543 & 93555-26) was done or not. Due to the patients condition you may not always be able to do the ventriculography but in most cases the pressure measurements are taken. "on pullback across the aortic gradient" are usually the key words I look for.


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