Cardiology Coding Alert

Payer preference and anatomic side may change your coding.

You typically need more than one hand to count all the codes that apply to a single heart catheterization session, so you have to take extra care to be sure you catch every appropriate code.

Scenario: A reader submitted a question about proper coding for a left heart catheterization, but the most troublesome aspect may be the iliofemoral angiogram performed at the same session. Here's the case in question: The cardiologist performs a left heart cath, coronary angiogram, left ventriculogram, and right iliofemoral angiogram.

Read on for some possibilities to consider, but remember that proper coding will always depend on the codes the documentation supports.

Find Injection and Imaging Codes When Available

LHC: For the left heart catheterization (LHC), report 93510-26 (Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery, percutaneous; Professional component).

Coronary angiogram: For the coronary angiogram, you should report both the injection procedure and the imaging supervision:

• 93545 -- Injection procedure during cardiac catheterization; for selective coronary angiography (injection of radiopaque material may be by hand)
• 93556-26 -- Imaging supervision and report for injection procedure(s) during cardiac catheterization; pulmonary angiography, aortography, and/or selective coronary angiography including venous bypass grafts and arterial conduits (whether native or used in bypass).

LV-gram: For the left ventriculogram, you should again report both injection and imaging supervision codes, with modifiers appended to the imaging supervision code:

• 93543 -- Injection procedure during cardiac catheterization; for selective left ventricular or left atrial angiography
• 93555-26 -- Imaging supervision and report for injection procedure(s) during cardiac catheterization; ventricular and/or atrial angiography.

Purpose Matters for Right Iliofemoral Angiogram

Access site assessment: For the right iliofemoral angiogram, check the documentation for whether the cardiologist performs the angiogram simply to assess the access site to see whether he can use a closure device. If so, you should not report 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation), says Christina Neighbors, MA, CPC, CCC, ACS-CA, charge capture reconciliation specialist and coder with St. Joseph Heart & Vascular Center in Tacoma, Wash.

For Medicare patients and payers who follow Medicare guidelines, the appropriate (but unpaid) HCPCS code is G0269 (Placement of occlusive device into either a venous or arterial access site, postsurgical or interventional procedure [e.g., angioseal plug, vascular plug]) for placement of the angioseal, says Neighbors. But physicians code this for statistical purposes only, she adds.

"There will be no additional reimbursement for this service." Same side as cath insertion: On the other hand, if documentation indicates the angiogram is truly a diagnostic lower extremity study, then for a Medicare patient and payers who follow Medicare guidelines consider G0278 (Iliac and/ or femoral artery angiography, non-selective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of the catheter in the distal aorta or ipsilateral femoral or iliac artery, injection of dye, production of permanent images, and radiologic supervision and interpretation [list separately in addition to primary procedure]).

Other side: If the cardiologist instead moves into the contralateral leg, then consider reporting 75710-59 and the appropriate catheterization code (such as, 36245-36247, Selective catheter placement ...). Check for the need to append modifier 59 to the cath placement code, as well.