Cardiology Coding Alert

" Two techniques are used to evaluate blood flow around or through a lesion, and both are reported with 93571 (intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement [coronary vessel or graft] during coronary angiography including pharmacologically induced stress; initial vessel [list separately in addition to code for primary procedure]) and 93572 (... each additional vessel [list separately in addition to code for primary procedure]).  
 
Whichever technique is used, this procedure, which previously could be used only in conjunction with an intervention, may now be reported when performed for evaluation only, i.e., during coronary angiography or cardiac catheterization.
 
Many cardiology coders are unfamiliar with both techniques or may not correlate the cardiologist's description of what was performed with the terminology that describes both codes. Depending on the technique performed, the procedure may be referred to as a fractional flow reserve study" " a "pressure wire" or a "Doppler ultrasonography." All the techniques aim to  evaluate accurately coronary blood flow and all are reported using 93571.
 
Coronary blood-flow evaluation provides important information to the cardiologist performing a heart cath or an intervention. Visual assessment of coronary-artery stenosis as viewed on angiography guides treatment decisions on the need for a revascularization procedure such as angioplasty atherectomy or coronary-artery bypass graft (CABG) surgery; however lesions of intermediate severity may require more evaluation.
In such cases cardiologists may measure coronary flow reserve (CFR) which is the ratio of coronary flow under maximal coronary vasodilation to coronary flow under resting conditions. CFR measurements greater than three are considered normal.
 
The measurement of pressure gradients across coronary stenoses was the earliest method used to assess the adequacy of coronary angioplasty but subsequently Doppler ultrasonography was considered more accurate and as a result is more often used. However the recent introduction of new thinner catheters and guidewires (often referred to as a "pressure wire") means pressure gradients can be accurately measured across stenoses before and after interventional procedures. The resulting data obtained by determining the ratio of the mean pressure distal to a coronary stenosis with that proximal of it are often referred to as a "fractional flow reserve" measurement says Marko Yakovlevitch MD FACP FACC a cardiologist in private practice in Seattle.
 
Some cardiologists maintain that with the new devices fractional flow-reserve measurement is easier to perform than Doppler ultrasonography which involves inserting a wire with a Doppler transducer at the tip of the wire to measure blood velocity. The transducer is mounted on a guidewire that is advanced through the stenosis in question to a position distal to the lesion. A baseline measurement of [...]