Cardiology Coding Alert

Question: Why does the cardiologist perform a transseptal puncture during a combined right and left heart catheterization, and when may I report it separately?

Wisconsin Subscriber

Answer: The term transseptal means through the septum. The septum is a wall of tissue separating the heart chambers.

For a combined right and left heart catheterization, the cardiologist performs a right heart catheterization by reaching the right atrium through the femoral, subclavian, internal jugular, or antecubital vein. He then passes the catheter through the tricuspid valve into the right ventricle and into the pulmonary arteries. Then the left heart catheterization involves puncturing the atrial septum to pass the catheter into the left ventricle.

There is a code specific to the transseptal puncture: +93462, Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure).

You may report +93462 in addition to the code for combined right (RHC) and left heart catheterization (LHC), 93453 (Combined right and left heart catheterization including intraprocedural injection[s] for left ventriculography, imaging supervision and interpretation, when performed).

You also may report +93462 as an add-on to left heart catheterization code 93452, coronary catheterization codes 93458-93461, patent ductus arteriosus code 93582, and electrophysiologic evaluation codes 93653 and 93654. 

You may not report +93462 in addition to 93656 (Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia including left or right atrial pacing/recording when necessary, right ventricular pacing/recording when necessary, and His bundle recording when necessary with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation). The code descriptor specifically states, “including transseptal catheterizations.”

Note that you should not use +93462 for transseptal puncture associated with 0345T (Transcatheter mitral valve repair percutaneous approach via the coronary sinus). But you may report +93462 with 0345T for transapical puncture, which refers to puncture through the left ventricular apex, or lowest point, of the heart.