Cardiology Coding Alert

Question: Which code is appropriate when the cardiologist performs a right heart catheterization and then inserts a catheter into the left ventricle and measures pressures, but there's no mention of an LV gram?

Georgia Subscriber

Answer: Depending on your documentation, consider 93526 (Combined right heart catheterization and retrograde left heart catheterization) to describe the service. Code 93526 essentially combines 93501 (Right heart catheterization) and 93510 (Left heart catheterization, retrograde, from the brachial artery, axillary artery, or femoral artery; percutaneous).

For the right heart catheterization, CPT notes with 93501 indicate the physician introduces the catheter into the venous system, and then into the right atrium, right ventricle, and pulmonary artery. CPT's notes for 93510 state the service involves inserting a catheter into the arterial system and then the left ventricle.

Heart catheterization doesn't require left ventricle imaging (LV gram). CPT guidelines state that diagnostic cardiac catheterization includes:

• introduction, positioning, and repositioning of catheters
• recording intracardiac and intravascular pressure
• obtaining blood samples to measure blood gases or dilution curves
• cardiac output measurements.

Bonus tip: Code 93526 is specific to non-congenital cases.

For patients with congenital cardiac anomalies, you should instead consider 93531 (Combined right heart catheterization and retrograde left heart catheterization, for congenital cardiac anomalies).