Cardiology Coding Alert

Question: When my cardiologist performs a heart catheterization, can I also code and bill for the placement of the cath in the subclavian artery? The cardiologist did not use this catheter placement to get to the LIMA. He did it for diagnostic purposes, then he placed a stent.


California Subscriber

Answer: If your cardiologist accesses the subclavians to do an extremity study during a heart cath, you can separately bill this procedure - as long as you have medical necessity established to perform the procedure.
 
As suggested by your question, if the physician was only using this subclavian catheter position to advance to the internal mammary arteries, the entire service would be included in the heart catheter placement code (93510 or 93508) and the appropriate imaging code (93539-26). 

For instance, Trailblazer's LMRP states that arteries subject to additional services include the subclavian, because normally an extra-cardiac angiography performed with a cardiac catheterization does not indicate the examination of such vessels. You shouldn't report this "unless specific conditions exist that would have ordinarily necessitated such additional selective investigation and treatments had the patient not required cardiac catheterization," the LMRP says. Check your own carrier for their policies.

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 Charlotte, N.C.