Cardiology Coding Alert

Question: Documentation from the cardiologist's op report states that he performed a heart catheter and intervention procedure. He used the Seldinger technique to insert a guiding catheter into the right femoral artery. Here is a snippet of the op report:

"Positioned a guiding catheter into the left main artery where I performed initial injections in different projections, revealing a 90 percent occlusion of the circumflex artery and sub-total occlusion of the obtuse marginal branch. I attempted for several minutes to cross the obtuse marginal occlusion without success. At this point, I decided to proceed with angioplasty and stenting of the circumflex artery."

Should I report 93510 in this case?

Kansas Subscriber

Answer: No, the op report doesn't support 93510 (Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous) because your cardiologist did not state he advanced the catheter across the aortic valve.

A cardiologist typically uses percutaneous puncture to place an introducer sheath in the femoral artery (such as Seldinger technique). He advances an angiography catheter through the sheath to the opening of the artery, conduit or venous coronary bypass (documentation might read "positioned guiding catheter into the left main artery"). Finally, the cardiologist injects contrast material or dye through the artery while recording a cineangiogram (he might indicate "I performed initial injections in different projections").

Do this: For these reasons, you should report 93508-26-51 (Catheter placement in coronary artery[s], arterial coronary conduit[s], and/or venous coronary bypass graft[s] for coronary angiography without concomitant left heart catheterization; professional component; multiple procedures).

You should also report the following codes:

Why: You should always include an injection code (93545) with the left cath series. Understand that 93556-26 represents the supervision and interpretation in a facility setting, while 92980 represents the stenting of the circumflex artery. Note: Remember to add modifier 26 to 93508 also.

-- You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in North Carolina.