Cardiology Coding Alert

Question: Our cardiologist performed a percutaneous transluminal coronary angioplasty (PTCA) and stent on the right coronary artery. His procedure description also states he performed a left heart catheterization. But, the body of the report only describes the stent placement and PTCA. The physician believes he shouldnt have to dictate the left heart cath because the stent cannot be placed without it. I dont want to bill for a left heart cath that is not described in the operative report. The cardiologist refuses to write an addendum. What should I do?

New Mexico Subscriber

Answer: Send the operative report with the claim. The coders concerns are justified for two reasons. First, carriers want to see documentation for any procedures performed. The coding adage Not written, not done applies today more than ever, and in the event of an audit the cardiologist may have to refund any fees paid for the heart cath and may also face financial penalties for billing an undictated procedure.

Second, says Gaye Boughton-Barnes, CPC, MPC, CCS-P, senior medical compliance specialist with the University of Oklahoma Medical College in Tulsa, if as the cardiologist says the stent cant be performed without a heart cath, the cath is bundled to the stent. Left heart caths (93510, left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous) may be separately payable when performed during the same operative session as a stent or other intervention, but only if they are diagnostic (i.e., if the results of the left heart cath led to the decision to perform the stent). In such cases, the catheterization must be documented.

Often, however, the diagnostic cath has been performed previously, and a second left heart cath or, in some cases, coronary angiography that doesnt cross the aortic valve (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) is performed only to guide the placement of the stent. In these cases, 93510 or 93508 should not be billed because there is no medical necessity for the procedure and the catheter placement is included in the intervention.

Note: If coronary angiography or a second heart cath is performed before the intervention because another problem has been identified, 93510 or 93508 can be billed separately. In these situations, the appropriate ICD-9 code to describe the new problem should be linked to the catheterization or coronary angiography.