Cardiology Coding Alert

Question: What CPT^® code should we report if the cardiologist performs an endomyocardial biopsy?

Florida Subscriber

Answer: You would report 93505 (Endomyocardial biopsy) for an endomyocardial biopsy (EMB).

An EMB involves the percutaneous introduction of a venous sheath system into the internal jugular or femoral vein using sterile techniques, local anesthesia, and appropriate sedation. Using a procedure similar to that described for right-heart catheterization (93451, Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed), the cardiologist directs a guiding sheath into the internal jugular or femoral vein. Under fluoroscopic guidance, the cardiologist directs a bioptome through the sheath to the right ventricular endocardium where a biopsy sample is excised from the myocardium, withdrawn with the bioptome, and placed in fixative. The cardiologist repeats the biptome insertion/biopsy until three to eight samples have been obtained. Following the EMB, the cardiologist removes the catheter and sheath and the cardiologist or the technician under his supervision achieves hemostasis.

Reminder: The cardiologist may report EMB separately in addition to a cardiac catheterization code, according to Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC's Certified Cardiology Coder steering committee. However, if the cardiologist only performs the cardiac catheterization as a means of obtaining the biopsy, and a separate identifiable diagnostic catheterization is performed, then you should report only the EMB.

Indication for billing a right heart catheterization at the same time of EMB must be clearly documented in the patient's record. Post-heart transplant without further explanation isn't sufficient to capture both the right heart catheterization and the EMB during the same encounter.

Elective, periodic, routine, surveillance right heart catheterization and EMB are not diagnostic and should not be charged separately, Neighbors says. It's standard protocol for RA/RV pressures to be performed on status post heart transplant patients. When and if pulmonary artery and pulmonary capillary wedge positions are performed (Swan Ganz or Berman is typically used) the cardiologist must clearly state why he performed a complete right heart catheterization along with the EMB.

"When ordering and discussing indications for performing a diagnostic right heart catheterization, the words "elective," "periodic," "routine," and "surveillance" should never be in the same sentence or written on the order," Neighbors recommends.

Reminder: There is no additional reimbursement for right heart catheterization done for reasons other than hemodynamic evaluation. This is included and bundled with the EMB procedure.