Cardiology Coding Alert

Question: My cardiologist performed a coronary angiography and measured right heart pressures but did not do a left ventriculogram (LVG) or measure any pressures on the left side of the heart. I've been reporting 93508 and 93501 together. Is this correct?

Mississippi Subscriber Answer: Yes, you can report 93508 (Catheter placement in coronary artery[s], arterial coronary conduit[s], and/or venous coronary bypass graft[s] for coronary angiography without concomitant left heart catheterization) and 93501 (Right heart catheterization) together. No National Correct Coding Initiative (NCCI) edit prevents this.

For example, a cardiologist may not be able to perform a full left and right heart cath when a patient has an artificial valve or critical aortic stenosis. She performs a right heart catheterization and a coronary angiogram, which you should report using:

93501-26

93508-26

93545 (Injection procedure during cardiac catheterization; for selective coronary angiography [injection of radiopaque material may be by hand])

93556 (Imaging supervision, interpretation 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]) with modifier -26 as well. You append modifier -26 (Professional component) to codes (93501, 93508 and 93556) to denote that the cardiologist performed these procedures in a cath lab and/or a hospital setting.

The injection code (93545) does not require modifier -26. Medicare does not have separate payment for professional and technical components for these codes. A good rule of thumb is to look at the M/C fee schedule to see if  modifier -26 is necessary.