Cardiology Coding Alert

Cardiologists sometimes confuse 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) and 93510 (left heart catheterization, retrograde, from the brachial artery, axillary artery and femoral artery; percutaneous) in their procedure notes. For example, the top of the op note may list left heart cath among the procedures performed, but the procedure notes describe coronary angiography without left heart catheterization.

Coders need to make sure their cardiologists indicate what they did either left coronary angiography or left heart cath in the procedure notes and at the top of the op report.

At some teaching hospitals, for instance, cardiologists often report a left heart cath, but their notes specifically describe that there was no injection into the left ventricle and no measurement of left ventricular pressure. This fits the definition of the coronary angiography, 93508, which involves catheter placement that doesnt cross the aortic valve into the left ventricle.

In other hospitals and in private practice, coronary angiograms also are sometimes described as left heart caths. Martha Gerant, CPC, a coder for Cardiology Services, an 11 physician practice in Shawnee Mission, Kan., says when what should be a 93508 is incorrectly described as a left heart cath, the error is caught because she reviews all cath labs claims before they are billed. If the documentation doesnt indicate the aortic valve was crossed, she will discuss the procedure with the cardiologist, who will confirm the procedure was coronary angiography or, less likely, revise the notes to indicate a left heart cath did occur.

After determining that the procedure was in fact a coronary angiogram without a left heart cath, the coder can review the op note for indications that would allow this second coronary angiogram to be paid, as outlined in the main story.