Cardiology Coding Alert

CPT Codes 2002 covers procedures performed on patients with congenital heart disease and other anomalies. There are many kinds of congenital heart diseases, their variety and complexity setting them apart from other heart conditions. Although children (typically newborns or infants under 2 years) make up the vast majority of patients who require procedures to treat congenital heart disease, adults may also have congenital heart anomalies that require treatment.
 
The treatment of congenital heart disease often requires high technical skills and involves high risk, meaning the cardiologist must spend more time pre-operatively reviewing the patient's records, previous surgeries and cardiac catheterizations. "It's the loss of normal expected anatomy that makes these procedures much more complicated," says Marko Yakovlevitch, MD, FACP, FACC, a cardiologist in private practice in Seattle. "With a routine catheterization, once the correct catheter is set up, it usually gets to where it needs to go relatively easily. But with congenital patients, the anatomy is so distorted you can't just go through the usual series of steps to get there. It's often much more difficult."
 
CPT 2002 covers cardiac catheterization procedures for patients with congenital anomalies, as well as echocardiograms performed on these patients.
Cardiac Catheterization
CPT offers the following for reporting treatment of congenital heart conditions:

93530 Right heart catheterization, for congenital cardiac anomalies.
 
This procedure differs from a typical right heart catheterization CPT 93501 (Right heart catheterization) in that the cardiologist measures pressures, takes blood samples for oximetry and may inject contrast to define the patient's anatomy. Blood samples are taken from the inferior and superior vena cava, as well as from sites in the right atrium, right ventricle and pulmonary artery, Yakovlevitch says. If a right ventriculogram is also performed, report it separately using 93542 (Injection procedure during cardiac catheterization; for selective right ventricular or right atrial angiography). Supervision and interpretation may also be billed separately using 93555 (Imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; ventricular and/or atrial angiography).

93531 Combined right heart catheterization and retrograde left heart catheterization, for congenital cardiac anomalies.
 
Although the professional component of this procedure is similar to 93526 (Combined right heart catheterization and retrograde left heart catheterization) with modifier -26 (Professional component) appended, it reimburses at a higher rate 12.05 relative value units (RVUs) for professional services versus 8.8 RVUs for 93526-26 because there is a congenital anomaly. The higher reimbursement reflects the fact that the procedure may take much longer due to what the cardiologist may encounter and may be required to do, notes Yakovlevitch. Again, injection procedures and supervision and interpretation should be reported separately.

93532 Combined right heart catheterization and transseptal left heart catheterization through intact septum with or without retrograde left heart catheterization, for congenital [...]