Cardiology Coding Alert

Question: How does an unplanned vs. planned intervention change my coding?

Tennessee Subscriber Answer: Depending on whether the interventional procedure is planned or unplanned, you may or may not report a diagnostic catheterization code.

For example, your cardiologist plans for and schedules a coronary interventional procedure (angioplasty, atherectomy or stent placement). In this case, you should not report the cath placement (93508-93510) or any diagnostic imaging (such as 93543, Injection procedure during cardiac catheterization; for selective left ventricular or left atrial angiography; or 93545, ... for selective coronary angiography [injection of radiopaque material may be by hand]) at the time of the procedure.

Why? The intervention codes are package codes and include everything involved. In other words, if your cardiologist knows where the blockage is but needs to inject dye to do the intervention, he is establishing roadmaps, which aren't reimbursable.

On the other hand, if a diagnostic catheterization leads to an urgent, unplanned intervention, you can report the full diagnostic heart catheterization and the interventional codes and receive separate reimbursement.

Medicare and other payers, however, commonly reduce the heart catheterization reimbursement (93510, Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous) by 50 percent when a cardiologist performs an intervention at the same time. This reduction is controversial because CPT lists 93510 as exempt from modifier 51 (Multiple procedures). In every other case, this exemption means that no multiple-procedure reduction applies.