Avoid Incorrectly Billing for Second Coronary Angiogram
Published on Thu Jun 01, 2000
Coronary angiograms performed before therapeutic interventions PTCAs (angioplasties), atherectomies and stents are payable procedures. A second angiogram, however, is usually considered part of the therapeutic procedure and shouldnt be billed, coding experts say.
Although some cardiologists routinely bill for a coronary angiogram and are reimbursed by many payers (including some local Medicare carriers), it is correctly billed and paid only when the medical necessity for performing the procedure is documented.
After a cardiologist performs a left heart catheterization, he or she may determine that the patient requires therapeutic intervention, and a PTCA, atherectomy or stent often is performed during the same session. But sometimes, the patient may have to return for the therapeutic intervention later the same day or on a different day. This can occur, for example, if the patient has an adverse reaction to the original procedure, or if the cardiologist who performed the cath doesnt perform therapeutic interventions during the initial operation.
When the patient returns for the therapeutic intervention, a second coronary angiogram routinely is performed. Unlike the earlier procedure, this catheter typically will not cross the aortic valve into the left ventricle; when that is the case, it is not considered a left cardiac catheterization.
In 1997, CPT Codes introduced a new code for this procedure: CPT 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).
Note: Code 93508 is considered a component of code 93510 (left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous) code 93511 (by cutdown), code 93524 (combined transseptal and retrograde left heart catheterization) and code 93526 (combined right heart catheterization and retrograde left heart catheterization) and is not reported if any of these procedures were performed. As with these left heart cath codes, injection procedures 93539-93545 and supervision and interpretation codes (93555, 93556) are separately reportable.
This procedure should be billed only if there is a significantly different problem, or the cardiologist suspects a separate lesion in another vessel or a second lesion in the same vessel, says Gay Boughton-Barnes, CPC, MPC, CCS-P, a cardiology coding and reimbursement specialist at the Tulsa, Okla., office of CPA firm Baird, Kurtz & Dobson.
For example, during the course of a pre-op for an angioplasty, the interventional cardiologist determines the patient is having a recurrent episode of chest pain. For diagnostic purposes, the cardiologist performs a second coronary angiogram (without crossing the aortic valve). Because this procedure has been prompted by a patient indication (the chest pain), the coronary angiography can be billed in addition to a stent, as follows: 93508-26, 93545, 93556-26-59, 92980 (stent).
Note: Because stent procedures already include supervision and interpretation, modifier -59 is added to the 93556 [...]
