Cardiology Coding Alert
Follow Expert Guidance to Improve Your Swan-Ganz Coding
Hint: Never report 93503 with other diagnostic cardiac catheterization codes. If your physician performs Swan-Ganz catheter procedures, you must pay attention to numerous details in the documentation, including if there were multiple catheters inserted, as well as if imaging was performed. Missing crucial details could put you at risk for a denial. Read on to keep your Swan-Ganz coding on the up and up. Figure Out What Swan-Ganz Catheter Is A Swan-Ganz catheter is a long, thin tube with an inflatable balloon tip that allows the catheter to move smoothly through the blood vessels and heart. Providers place an introducer sheath into a major vein like the internal jugular, subclavian, or femoral, which lets the catheter enter the body more easily. At that point, blood flow directs the Swan-Ganz catheter through the veins, the right side of the heart, and the pulmonary arteries (PAs) that carry blood to the lungs. The different ports of a Swan-Ganz catheter have the following functions: Terminology: If you see the term “pulmonary artery catheter (PAC)” in the documentation, this is the same as a Swan-Ganz catheter, says Kelly D. Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPMA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Florida. You may also see a Swan-Ganz catheter called a balloon flotation flow-directed catheter. Report 93503 for Swan-Ganz Catheter Providers will typically place a Swan-Ganz catheter in patients with certain types of severe cardiac conditions or whose cardiac function might be compromised before or during surgery. They use the Swan-Ganz catheter as a diagnostic tool to monitor heart and lung function, evaluate hemodynamics, and determine the effectiveness of medications. Additionally, providers use a Swan-Ganz catheter to measure important indicators of cardiovascular function including central venous pressure (CVP), right atrial pressure, PA pressure, cardiac output (amount of blood ejected by the heart per minute), and venous oxyhemoglobin saturation (SvO2). If your provider places a Swan-Ganz catheter, report 93503 (Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes). You should report this “for placement of a flow-directed catheter (e.g., Swan-Ganz) performed for hemodynamic monitoring purposes not in conjunction with other catheterization services,” per the CPT® guidelines. Tip: Never report 93503 in conjunction with other diagnostic cardiac catheterization codes, according to the guidelines. Understand How to Report Multiple Catheters When you find op reports that mention multiple catheters, you must unravel which are or aren’t separately reportable. Documentation of other lines placed in addition to the Swan-Ganz doesn’t automatically mean you can report each line separately. Pay attention to the details to verify what you can legitimately code. “One detail you must confirm to get the coding right is the number of access sites,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, product manager at MRO in Philadelphia. Same access site: When placing a Swan-Ganz catheter, the provider might thread it through a central venous catheter (CVC) line. According to anesthesia coding guidelines, the central line (36555 or 36556) is considered part of the Swan-Ganz procedure when placement is through the same access site. Because the CVC placement is included in the Swan-Ganz fee, you normally report only the SGC placement with 93503 instead of coding for both lines. Different insertion sites: It’s not unusual for the provider to place a Swan-Ganz to monitor cardiac output and a separate the CVC line at a different location based on the need for multiple intravenous access ports. If you have clear documentation supporting the separate sites, append modifier 59 (Distinct procedural service) or XS (Separate structure …) to the central line code to override the edit pair. You’re in the clear, however, if the physician also places an arterial line in addition to the Swan-Ganz. In cases where they document these two or all three lines, you can report both the arterial line (36620) and the SGC (93503) on the claim. Handle Imaging With Care After inserting a Swan-Ganz, your provider may perform a chest X-ray to confirm the proper placement and positioning of the flow-directed catheter. When they do, you should not additionally report the chest X-ray because the National Correct Coding Initiative (NCCI) edits bundle codes such as 71045 (Radiologic examination, chest; single view) with 93503. Here’s why: “Without new symptoms or other documented cause, you should always bundle standard diagnostic procedures as part of the primary procedure, such as electrocardiograms [EKGs] and X-rays that the provider performs pre- and/or post-procedure to verify the work,” Brame-Joy says. But when your provider uses ultrasound guidance to aid with line placement, you can report add-on code +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting …) along with line placement codes 36556, 93503, or 36620. Be sure to include modifier 26 (Professional component) for proper reimbursement. Don’t Forget Relevant ICD-10-CM Codes Your provider should always document the specific reason for Swan-Ganz monitoring. Make sure to review the patient’s chart and medical history for potential diagnoses that would support medical necessity. Although the advent of newer noninvasive technologies such as echocardiography may supplant Swan-Ganz in some cases, clinicians often still use Swan-Ganz catheters for circumstances including the following: Notice: If your surgeon is involved in trauma treatment using Swan-Ganz catheters, you should note that critical care services are separately reportable. Meagan Williford, BA, MA, CPC, Contributing Writer 
Cardiology Coding Alert
