Cardiology Coding Alert

Learn why you need to make the diagnostic-vs.-monitoring distinctionIf coding right heart catheterizations -- particularly procedures that include Swan-Ganz catheters -- sets your heart aflutter, a few minutes brushing up on the basics could be just what you need to improve your cath coding acumen.Here's how: Take a look at the following right heart cath procedure and see if you're on par with our expert- provided coding recommendations.Procedure OverviewA 58-year-old male patient with myocardial infarction and cardiogenic shock received left heart catheterization, left ventriculography and selective coronary angiography through the right femoral artery in the cath lab and stenting in the left anterior descending (LAD) coronary artery. He also had intra-aortic balloon catheter placement. He had right heart catheterization through the right femoral vein with a Swan-Ganz catheter.The Operative NoteThe physician recorded the patient's resting hemodynamics with a 7 French Swan-Ganz catheter. He completed left ventriculography and selective coronary angiography with a 6 gauge French catheter through the right femoral artery. He traversed the total occlusion of the left anterior descending coronary artery with a 0.014 ostial wire. He performed predilatation with a 3.0-mm x 15-mm Maverick balloon. Next, he deployed a 3.0-mm x 33-mm velocity stent in the left anterior descending coronary artery.The physician inserted an intra-aortic balloon catheter through the right femoral artery and initiated counterpulsation.He took hemodynamic measurements in the right atrium, which were 0 mm of mercury; the right ventricle, 13/2 mm of mercury; pulmonary capillary wedge pressure, 2 mm of mercury; pulmonary artery, 15/3 mm of mercury; the central aorta, 85/50 mm of mercury; the aortic valve, 169/82/153 mm of mercury; and the left ventricle, 85/80 mm of mercury.The procedure indicated severe three-vessel coronary artery disease and severe left ventricular dysfunction. The physician successfully completed an angioplasty and stenting of a totally occluded left anterior descending coronary artery and measured hemodynamics consistent with cardiogenic shock.Coding Advice: Follow These 6 StepsStep 1: Before you begin assigning any codes, read the note again to determine if the physician performed the procedure for diagnostic purposes, as in this case, or for monitoring, says Cheryl Klarkowski, RHIT, CPC, cardiology coding specialist at Baycare Health Systems in Green Bay, Wis.Why this is important: "If the service is diagnostic, the physician needs to perform it before he can determine a definitive treatment (such as a stent). If this is merely a monitoring situation, you should count the service as inclusive of the definitive procedure," Klarkowski says.Step 2: Start by reporting 93526-26 (Combined right heart catheterization and retrograde left heart catheterization; professional component) for the combined right and retrograde left heart catheterization. In this instance, the physician used a Swan-Ganz catheter to perform a diagnostic right heart catheterization to assess the patient's [...]