Cardiology Coding Alert

Question: I was at a seminar that said not to code diagnostic angiography for planned coronary interventions. I didn’t quite understand what to look for. Our patients often present for diagnostic caths knowing the intervention is possible if something is found. Is that planned?

California Subscriber

Answer: The situation you describe, where the patient presents for a diagnostic cath knowing an intervention is possible, is not “planned” the way the presenter meant it.

The issue of planned vs. unplanned boils down to this question: Was the angiography performed during the intervention as a diagnostic angiography service (as CPT^® defines diagnostic) or was the angiography simply roadmapping to assist with an intervention the cardiologist knows the patient needs based on prior diagnostic services?

CPT^® guidelines for 92920-92944, which represent percutaneous revascularization services for coronary vessels, state “Diagnostic coronary angiography may be reported separately under specific circumstances.”

Those same guidelines spell out the specific circumstances where you may report diagnostic services separately. Here’s a summary of when you may report the diagnostic service separately from an intervention performed at the same session:

• If there is no previous coronary angiography catheter-based study for the patient, the physician performs a full diagnostic study, and the physician decides to perform an intervention based on that study, then you may report the diagnostic service in addition to the same-session intervention
• If a previous study is available, but the patient’s condition changes in a clinically relevant way before the procedure, the previous study doesn’t provide adequate visualization of the area, or, during the procedure, the physician determines the patient needs a study performed outside the target area, then you may report the diagnostic service in addition to the same-session intervention.

Caution: The guidelines emphasize that the following are not separately reportable as diagnostic studies: roadmapping, guidance, contrast injections, and angiography for the intervention; vessel measurement for the intervention; and post-intervention angiography.