Coding Corner: Cast Off Your Cath Coding Confusion

Cross the aortic valve? Then set your sails for 93510

Don’t rock the boat when you’re deciding between diagnostic cath codes 93508 and 93510. Here’s the key: When you’ll report 93508 or 93510 depends on whether the doctor crossed the aortic valve with the catheter’s tip. 
Determine the Difference
You’ll find the difference between these two diagnostic cath codes in their definitions. Code 93510 (Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous) is for a full diagnostic left heart cath that includes catheter placement into the left ventricle and usually into the coronary arteries.
On the other hand, 93508 (Catheter placement in coronary artery[s], arterial coronary conduit[s], and/or venous coronary bypass graft[s] for coronary angiography without concomitant left heart catheterization) is for the same procedure--with the exception that the catheter did not enter the left ventricle, which would require the catheter to cross the aortic valve.
 
Strategy: You should look in the  documentation for proof that the physician crossed the aortic valve, says Jim Collins, CPC, ACS-CA, CHCC, CEO of The Cardiology Coalition in Matthews, N.C. For example, the following indicators show that the doctor provided a full left heart cath (93510):
• the description of his advancing the pig-tail catheter across the aortic valve;
• the measurements of intracardiac pressures (which require the catheter to be inside of the heart); and
• the performance/findings of a left ventriculogram (which also requires the catheter to be placed inside the heart).
Any of these factors will establish the diagnostic study as a full left heart cath (93510) rather than catheter placement in the coronary arteries (93508).
Learn by Example
How you’ll report 93508 and 93510 relies heavily on the operative report. Word of caution: Because of the nature of unexpected interventions, you may find hints to the wrong code right at the beginning, so make sure you read the entire report before making your diagnostic cath selection.
Case study: The physician performs a heart cath and intervention procedure. Using the Seldinger technique, he inserts a guiding catheter into the right femoral artery. His op report reads: “Positioned a guiding catheter into the left main artery where I performed initial injections in different projections, revealing a 90% occlusion of the circumflex artery and sub-total occlusion of the obtuse marginal branch. I attempted for several minutes to cross the obtuse marginal occlusion without success. At this point, I decided to proceed with angioplasty and stenting of the circumflex artery.”
Warning: You might be tempted to report 93510, but the op report does not support this code because the physician did not state he advanced the catheter across the aortic [...]

- Published on 2006-03-23