Cardiology Coding Alert

Remember: You should report specific codes for congenital heart disease caths.

Understanding cardiac catheters can be extremely challenging. Not only must you always read and understand CPT^®’s lengthy guidelines on the subject, but you must also double check your cardiologist’s documentation to make sure you choose the correct cath code and avoid confusing them.

Read on to learn some of the most common errors people make when reporting caths and how you can avoid these errors in your own practice.

Error 1: You Reported the Wrong Cath Procedure

Mixing up cath codes is a common mistake that new coders sometimes make.

“One thing I always tell someone just starting out with coding heart catheterizations is to first read the introduction to CPT^® codes in the CPT^® code book because this gives you so much information on how to correctly use these codes,” says Theresa Dix, CCS-P, CPMA, CCC, ICDCT-CM, coder/auditor of East Tennessee Heart Consultants in Knoxville, Tennessee. “Study the codes so you know the difference.”

Dix uses 93452 (Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed) and 93458 (Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed) as an example. Both 93452 and 93458 are left heart caths, Dix says. However, 93452 is for LV assessment only; there is no angiography done of the patient’s coronaries. “On the other hand, 93458 should be reported for cath placement in the coronaries for coronary angiography/LV gram (when performed).”

And, codes 93451 (right heart cath), 93452 (left heart cath) and 93453 (right and left cath including the work of both 93451 and 93452) are heart caths without coronary angios, Dix says. “If the physician performs coronary injections, you should not use these codes. You should instead look to code 93454 (Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation) or higher.”

Error 2: You Mixed up Congenital Codes With Non-Congenital Heart Disease Cath Codes

CPT^® categories the codes for cardiac catheterization into two families: one for congenital heart disease and one for all other conditions. So, you must keep this in mind when reporting the cardiac cath codes.

You should report the following codes for congenital heart disease (CHD) caths:

• 93530 (Right heart catheterization, for congenital cardiac anomalies)
• 93531 (Combined right heart catheterization and retrograde left heart catheterization, for congenital cardiac anomalies)
• 93532 (Combined right heart catheterization and transseptal left heart catheterization through intact septum with or without retrograde left heart catheterization, for congenital cardiac anomalies)
• 93533 (Combined right heart catheterization and transseptal left heart catheterization through existing septal opening, with or without retrograde left heart catheterization, for congenital cardiac anomalies)

Non-congenital heart disease codes: On the other hand, you should report 93451 (Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed)-93461 (Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography) for all other conditions.

Don’t miss: You should not report 93530-93533 if the patient’s only congenital anomaly is isolated patient foramen ovale (PFO), mitral valve prolapse, bicuspid aortic valve, or anomalous coronary arteries. Instead, according to the CPT^® guidelines, under these circumstances, you should report 93451-+93464 (Physiologic exercise study ...) and +93566 (Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective right ventricular or right atrial angiography ...) through +93568 (Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for pulmonary angiography ...).

Error 3: You Didn’t Double Check the Documentation

You must carefully check the documentation when reporting cardiac caths to avoid making errors.

Carol Hodge, CPC, CDEO, CCC, CEMC, certified medical coder at St. Joseph’s Cardiology in Savannah, Georgia, recounts some of the common mistakes she has seen practices make when reporting caths: “I worked with a practice just last week on this issue,” Hodge says. “What was happening then was 93459 (Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography)-26 was being billed for patients who have never had bypass surgery. I also see just opposite — a cath with the selective grafts clearly documented being coded as one without grafts.”

Hodge also adds that she sees cases where a complete cath is coded when the aortic valve was not crossed. “If the aortic valve is not documented as being crossed, then a limited cath must be billed,” according to Hodge.

Also, Hodge says that she sometimes sees where right and left heart caths are billed as left heart caths. If a venous access and arterial access are performed, there’s a strong possibility a combined right and left heart catheterization was provided, adds Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee.

To avoid these mistakes, you must carefully read the documentation for the procedure to determine exactly what was done, Hodge says. The physician must be careful to document everything he does.

“Additionally, coders must have the proper training to code these types of procedures from the note and not from a ‘cheat sheet’ or a ‘list of codes’ we usually bill,” Hodge says. “Coders need to be very familiar with all of the cardiac caths and what is included in them.”