Cardiology Coding Alert

Differentiate between selective, nonselective caths.

Reporting heart catheters may seem tricky because not only must you learn how to properly report the congenital heart cath codes, but you must also know what to do when your cardiologist performs right heart caths with other cath services.

Answer these frequently answered questions (FAQs) to keep your cath coding on track.

FAQ 1: Why Do Physicians Perform Diagnostic Heart Caths?

Answer 1: Physicians use diagnostic heart catheterizations to assess cardiac function and the patency of the coronary arteries. Blockages in these arteries deprive the myocardium of the oxygen-rich blood it relies upon for energy and nutrients. Different factors can cause blockages; the most common is the gradual buildup of cholesterol.

When the physician performs a heart catheterization, they can develop an optimal treatment plan for the patient, which can include medication management, percutaneous intervention, or coronary artery bypass grafting.

FAQ 2: What Is The Difference Between Selective, Nonselective Caths?

Answer 2: Selective catheterization occurs when the cardiologist advances a catheter into a main branch off of the aorta or vena cava or off the vessel they initially entered.

On the other hand, with nonselective catheterization, the cardiologist places the catheter directly into the assessed blood vessel. In this type of situation, there is no manipulation or advancement of the catheter into other branches of that vessel, or they only negotiate the catheter into the thoracic or abdominal aorta, inferior vena cava, or superior vena cava, and then they remove it.

Selective caths: The cardiologist accessed the brachial artery percutaneously and placed a sheath. Next, they threaded a guidewire through the sheath into the thoracic aorta. They then placed a catheter over the guidewire into the arch of the aorta and performed cervicocerebral angiography. They moved the catheter into the vertebral artery. The cardiologist injected contrast material through the catheter into the blood circulation. They performed imaging supervision and interpretation for angiography with several X–rays of the ipsilateral vertebral circulation and cervicocerebral arch. Report 36226 (Selective catheter placement, vertebral artery, unilateral, with angiography of the ipsilateral vertebral circulation and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed) for this selective cath example.

Nonselective caths: The cardiologist introduced a catheter into the patient’s common femoral artery, advanced it into the aorta, and performed an abdominal aortogram. Then the cardiologist removed the catheter. Report 36200 (Introduction of catheter, aorta) and 75625 (Aortography, abdominal, by serialography, radiological supervision and interpretation) for this nonselective catheterization service.

FAQ 3: What Codes Should You Report When the Cardiologist Performs Right Heart Cath With Other Cath Services?

Answer 3: When a right heart cath is performed in conjunction with other cardiac cath services, you have several options.

For example, for non-coronary combined right and left heart cath, report 93453 (Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed).

Then, for right heart cath with coronary artery involvement, report 93456 (Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization).

Next, for right heart cath with coronary artery involvement with coronary artery bypass graft (CABG), report 93457 (Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization).

For right and left heart cath with coronary involvement, report 93460 (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).

Lastly, for right and left heart cath with coronary involvement with CABG, report 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).

“A right heart catheterization measures the pressures in the right atrium, right ventricle, and pulmonary artery, a left heart catheterization measures pressures in the left ventricle and assesses the aortic valve, and a coronary artery catheterization visualizes for any atherosclerosis within the coronary vessels,” says Robin Peterson, CPC, CPMA, manager of professional coding and compliance services, Pinnacle Enterprise Risk Consulting Services, LLC in Centennial, Colorado. “It’s helpful to know when it comes to catheter access for heart catheterization, right heart access is through a vein, while for left heart and/or coronary artery catheterization, access is through an artery. Therefore, for a combined right heart and left heart and/or coronary artery catheterization, you should expect to have two access sites.”

FAQ 4: How Do I Handle Congenital Heart Caths?

Congenital heart caths have a special section of codes in the CPT^® manual. They are as follows:

• 93593 (Right heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone; normal native connections) and 93594 (… abnormal native connections)
• 93595 (Left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone, normal or abnormal native connections)
• 93596 (Right and left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone(s); normal native connections) and 93597 (…abnormal native connections)
• +93598 (Cardiac output measurement(s), thermodilution or other indicator dilution method, performed during cardiac catheterization for the evaluation of congenital heart defects (List separately in addition to code for primary procedure)). If your cardiologist performs thermodilution cardiac assessments during right heart catheterization for congenital heart anomalies, you may separately report this service with the add-on code +93598.

Coding tip: When reporting these congenital heart cath codes, you must be aware of the type of native connection to choose the appropriate code. These codes can be used with normal native or abnormal native connections.

Normal connections for the pathway of blood flow are through the right and left heart chambers and great vessels. Abnormal connections (right to left blood flow) are usually cyanotic and patients are commonly described as “blue.”