Cardiology Coding Alert

Question: An intracardiac echocardiogram is performed in the catheterization lab following a catheterization/stent procedure. We considered coding 93662 but have been told that this code should be used as an add-on only for electrophysiology studies and ablations. Is this correct?
         
New York Subscriber
 
Answer: Although electrophysiology studies are not specifically mentioned in the descriptor for 93662 (Intra-cardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation [list separately in addition to code for primary procedure]), CPT 2002 lists the following codes to which 93662 may be added: 93621-93622 (electrophysiology studies) and 93651-93652 (ablations).
 
Even though the cardiologist performed a diagnostic procedure (the heart catheterization) and a therapeutic procedure (the stent), 93662 should not be reported. Instead, report 93799 (Unlisted cardiovascular service or procedure). Unlisted-procedure codes are automatically reviewed; therefore, the claim should be submitted manually with the patients record, which should clearly and accurately document the intracardiac echocardiogram and why it was performed. The carrier is likely to scrutinize the notes to determine if it qualifies as a medically necessary service. Additionally, a price should be determined for the service, because unlisted procedures are not on the Medicare fee schedule. The fee for 93662-26 (Professional component) (4.33 RVUs) may be used as a guide to determine the correct fee for 93799.
 
Note: Carriers can determine whether to cover and how much to pay for global code 93662 and 93662-TC (Technical component). Only the professional component of the procedure (93662-26) is a nationally covered Medicare service.