Cardiology Coding Alert

Question: We're having trouble getting 93527 reimbursement. I've heard we should use modifier 26. Is this true?

California Subscriber

Answer: The Medicare Physician Fee Schedule only prices the professional component of 93527 (Combined right heart catheterization and transseptal left heart catheterization through intact septum [with or without retrograde left heart catheterization]). You should represent this as 93527-26 (Professional component).

Crucial: Code 93527 is appropriate when the cardiologist performs a combined (right and left) diagnostic heart catheterization that happens to include a transseptal puncture.

If the cardiologist instead performs transseptal punctures to ease complex electrophysiologic procedures, such as atrial fibrillation ablations, you should not use 93527.

Try this: Experts advise attaching modifier 22 (Increased procedural services) to the ablation, for example, supraventricular tachycardia (SVT) ablation code (93651-22, Intracardiac catheter ablation of arrhythmogenic focus; for treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathways, accessory atrioventricular connections or other atrial foci, singly or in combination).

To support your modifier 22 use, be sure your physician documents the extra time involved and lists the procedural details of the transseptal puncture. But be prepared to appeal for extra reimbursement.

Term tip: The "septum" is the wall that separates the heart's right and left sides. The heart has an atrial septum and a ventricular septum. A transseptal puncture involves accessing one side of the heart (typically the left) by first placing a catheter in the opposite side (usually the right) and then puncturing the septum (usually the atrial septum).