Cardiology Coding Alert

Question: How should I bill for a left inferior mammary artery (LIMA) and right inferior mammary artery (RIMA) bypass graft during a cardiac cath? And do I need any modifiers?

New Hampshire Subscriber

Answer: For the RIMA and LIMA procedures, you should look to 93539 (Injection procedure during cardiac catheterization; for selective opacification of arterial conduits [e.g., internal mammary], whether native or used for bypass) when the cardiologist views the internal mammary arteries during a heart catheterization.

You'll base your catheterization code on the other portions of the procedure. Typically, you'll report 93510 (Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous). If your cardiologist performs a right and left heart catheterization, you'll report 93526 (Combined right heart catheterization and retrograde left heart catheterization)

Watch out: Typically, 93539 will include the imaging portion, so you should not also report 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]).

Finally, for this procedure, you shouldn't need to use any modifiers.