Cardiology Coding Alert

Question: My cardiologist stated that he performed limited coronary angiography and an intravascular ultrasound (IVUS). How should I bill this?

North Carolina Subscriber

Answer: Most likely, the cardiologist meant that he or she performed angiography on only one coronary artery. In this case, you should 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) appended with modifier -26 (Professional component) if the procedure was performed in a facility other than the physician's office.

You should also bill 93545 (Injection procedure during cardiac catheterization; for selective coronary angiography [injection of radiopaque material may be by hand]) and 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]). You should append 93556 with modifier -26 as well.

Finally, you should report the IVUS using +92978-26 (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]).

Note: Codes 93545 and 93556 are paid if only one coronary artery is injected and imaged or all are injected and imaged.