# LIMA angiography during cardiac cath



## jbhansen

I am scheduled to have a discussion with a physician regarding how LIMA angiography is to be billed when performed during a cardiac catheterization.  I have been researching this issue and haven't been able to come up with a conclusive answer with firm back-up to support it.
The type of angiography in question is performed during a LHC in which coronary angiography reveals disease. In the likelihood the patient proceeds to having CABG, they perform a LIMA angiogram to evaluate whether the vessel will make a good bypass graft or not.  These are most often performed selectively (cath in LIMA itself) but sometimes the catheter is only advanced into the left subclavian artery.
It is my understanding that code 93539 and S&I code 93556-26 would be used if the catheter is advanced selectively into the LIMA or the left subclavian (since that too is "selective").
However one could argue that 93539 is only for bypass grafts.  I found the following from CPT Assistant, but it is a bit old and may be outdated:
_Coding Consultation: Questions and Answers 
CPT® Assistant October 2001 Volume 11 Issue 10 

Question
I am unsure which structures the term "conduits" refers to in the descriptor for code 93539. Would you please explain this further?

AMA Comment
From a CPT coding perspective, the term "conduits" as used in code 93539, Injection procedure during cardiac catheterization; for selective opacification of arterial conduits (eg, internal mammary), whether native or used for bypass, refers to arterial bypass vessels. These "conduit" vessels would be present, for example, following a coronary artery bypass procedure._

One could argue that 36216 should be used if the LIMA is selectively catheterized (36215 if only the left subclavian is selected).  The problem arises in that the S&I code 75756-26 is bundled with the cardiac catheterization codes and cannot be modified per NCCI.  Would another S&I code (75650-26, 75710-26) be appropriate?

Any thoughts or sources that would back-up the use of either coding would be appreciated.  I would like to have all my ducks in a row before my discussion.  Thanks!


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## molly3

*LIMA code*

Did you ever find out an answer to this? I am new to cardio thoracic surgery and have seen this a couple of times. Any help is appreciated.

Jan Thatcher CPC


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## Davistm

The code description for 93539 states " "during cardiac catheterizations" ---"whether native or used for bypass".

If the physician performs angiography of an internal mammary artery [ies] *during cardiac catheterization*, then report 93539 whether the artery is in use as an arterial conduit or is being evaluated for possible use as an arterial conduit.  You cannot report additional cathetrization codes [36215 - 36217] no matter where the catheter is placed - the subclavian or the internal mammary.  Imaging supervision for angiography of arterial conduits is included in code 93556. [The code description for 93556 states "...and arterial conduits (whether native or used in bypass).

Only if the physician suspects [signs, symptoms, test results] subclavian disease [occlusion, stenosis, subclavian steal syndrome] would it be appropriate to report 36215/6 and 75710/75716-26 in addition to the codes for the cardiac catheterization.

Terry Davis
CPC


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## ybarde

*Subclavian angiogram of LIMA with LHC*

Hello,

My physician is doing left subclavian angiogram of LIMA(left intermal mammary artery) during LHC. My physician is asking to bill 36215 for subclavian angiogram of LIMA but finding of this angiogram always LIMA is patent. Can I code 36215 for left subclavian angiogram of LIMA performed during LHC even if there is no defect in artery or no abnormal findings?

Thanks in advance.


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## Jim Pawloski

ybarde said:


> Hello,
> 
> My physician is doing left subclavian angiogram of LIMA(left intermal mammary artery) during LHC. My physician is asking to bill 36215 for subclavian angiogram of LIMA but finding of this angiogram always LIMA is patent. Can I code 36215 for left subclavian angiogram of LIMA performed during LHC even if there is no defect in artery or no abnormal findings?
> 
> Thanks in advance.



A LIMA or RIMA injection is coded 93455 - Coronary Angio. w/ bypass grafts, or 93459 - LHC w/ bypass grafts. It can be billed if the doctor is looking at the vessel to be considered for CABG.

Thanks,
Jim Pawloski, CIRCC, R.T. (R)(CV)


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