Cardiology Coding Alert

Question: The cardiologist performed selective coronary angiography, and he used an IAB during the procedure. How would I code percutaneous IAB insertion and removal on the same date?

California Subscriber

Answer: You may report both the insertion and removal of the intra-aortic balloon (IAB) device when performed on the same day, according to CPT^® Assistant (November 2011).

For the insertion, report 33967 (Insertion of intra-aortic balloon assist device, percutaneous). The code for the removal is 33968 (Removal of intra-aortic balloon assist device, percutaneous).

Correct Coding Initiative (CCI) edits bundle 33967 into 33968, so you’ll have to append modifier 59 (Distinct procedural service) to 33967 to override the edit.

Also be sure to report the angiography service with the appropriate code, such as 93454-26 (Catheter placement in coronary artery[s] for coronary angiography, including intraprocedural injection[s] for coronary angiography, imaging supervision and interpretation; Professional component).

Physicians use IAB devices so the heart doesn’t have to work as hard. It also helps improve blood flow in the body. In many cases, the IAB device may be left in place for more than a day. But in other cases, the IAB device is used only for the surgical encounter and is then removed if the patient is stable enough post-procedure. According to CPT^® Assistant, you may see IAB device placement and removal on the same date for "acute myocardial infarction (MI). Other indications could be the intent to do a left main coronary artery percutaneous coronary intervention. Most IAB insertions for cardiogenic shock would not involve removal in the same setting."