Cardiology Coding Alert

Question: One of our managed-care plans insists that 92978 should be bundled with left heart catheterization. Is this correct, and if not, will you explain why?

Answer: This bundling is not correct, according to CPT guidelines. Code +92978 (Intravascular ultrasound [coronary vessel or graft] during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel [list separately in addition to code for primary procedure]) is an add-on code and describes additional intraservice work associated with but not included in the primary procedure.

In procedures using 92978, the physician advances the catheter to the tip of the coronary artery or graft that he or she is examining. The physician then advances a guide wire through this catheter and places a special ultrasound catheter over the wire into the appropriate vessel being visualized. The ultrasound probe provides a two-dimensional cross-section of the vessel.