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Cardiology Coding Alert

Reader Questions:

You May Have Trouble Reporting 414.01

Published on Wed Mar 23, 2005

Question: I reported 414.01 for a right and left heart cath and received a denial. The patient had an abnormal EKG in 2003. What should I do?

Montana Subscriber Answer: The reason you may have received the denial is that some carrier policies state that 414.01 (Coronary atherosclerosis; of native coronary artery) gives you medical necessity for the left heart catheterization (LHC) but not the right heart catheterization (RHC). If you check your carrier's local coverage determination (LCD) or local medical review policy (LMRP), you'll probably discover that you can't justify an RHC with 414.01. To do so, you would have to have a diagnosis in the pulmonary or heart failure range.

Tip: Search for local coverage policies for 93526 (Combined right heart catheterization and retrograde left heart catheterization). Most list one set of diagnoses for left heart cath only, another set for right cath only, and a third set for combined right/left heart caths.
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