Cardiology Coding Alert

Question: My cardiologist plans for and schedules a coronary interventional procedure (angioplasty, atherectomy or stent placement). Should I report the cath placement?

South Carolina Subscriber

Answer: 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; 93545, ... for selective coronary angiography [injection of radiopaque material may be by hand]; 93555, Imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; ventricular and/or atrial angiography; or 93556, ... pulmonary angiography, aortography, and/or selective coronary angiography including venous bypass grafts and arterial conduits [whether native or used in bypass]) 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, then he is establishing roadmaps, which aren't reimbursable.

However, if a diagnostic catheterization leads to an urgent, unplanned intervention, this advice would change. You would report the full diagnostic heart catheterization and the interventional codes and receive separate reimbursement.

Keep in mind: 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 modifier 51 (Multiple procedures) exempt. In every other case, this exemption means no multiple-procedure reduction applies.

Heads up: Make sure you attach modifier 59 (Distinct procedural service) to the radiological supervision and interpretation codes (93555-93556). Otherwise, insurers will bundle these diagnostic radiological services into the intervention, due to the Correct Coding Initiative (CCI) edits. These edits are based on the assumption that the diagnostic imaging is "roadmapping" rather than a separate diagnostic study.
 
-- You Be the Coder and Reader Questions prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC-CARDIO, president of CardiologyCoder.Com, Inc. and compliance manager for several cardiology groups around the country.