When billing cardiac catheterizations (heart caths), coders should make sure they bill for all the codes that apply, according to the operative report. This can be difficult, because the steps to gainful billing involve three separate components and many codes may apply to the situation.
In addition, even though heart caths are among the most common procedures performed by cardiologists, they are often difficult to understand. This is particularly true since some heart caths do not require injections and supervision and interpretation (S&I), and because the codes for this procedure actually describe more than one service.
Since 1994, when CPT reorganized the coding for cardiac catheterizations, a combination of codes from the following three categories has been used for most (but not all) heart caths:
1. Catheter placement
2. Angiography procedures
3. S&I of angiography
These codes are found in the medicine section of the CPT manual and range from 93501 to 93556. Cardiac catheterization usually is billed using only one code from the catheter placement section (93501-93536). Coding is based on the appropriate number of injections (angiograms) performed, the anatomical area being studied, and the appropriate S&I codes, which are determined according to the number and location of angiograms performed, says Terry Fletcher, BS, CPC, CCS-P, a
cardiology coding and reimbursement specialist in Laguna Beach, Calif.
When selecting the codes for any particular cardiac catheterization, coders need to carefully examine the op report to determine which procedures from each component were performed. The coder must also be familiar with the differences among the various code descriptions.
Note: In some situations, more than one catheter placement code can be billed. The American College of Cardiologys (ACC) Guide to CPT cites the case of a 45-year-old male who receives a left heart cath, including left ventriculography and coronary angiography. The results of the study necessitate immediate emergency aortocoronary bypass, which is preceded by the insertion of a Swan-Ganz catheter and an intra-aortic balloon catheter. These additional services, both catheter placement codes, are reported together as 93503 (insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes) and 93536 (percutaneous insertion of intra-aortic balloon catheter).
The following three guidelines will help the coder make the best heart cath coding choices:
Guideline No. 1:
Check Op Report Before Coding the Cath Insertion
CPT 2000 lists 17 distinct coronary catheter placement codes. Of these, cardiologists commonly use the following five:
93501 right heart catheterization
93503 insertion and placement of flow directed
catheter (e.g., Swan-Ganz) for monitoring purposes
93508 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
93510 left heart catheterization, retrograde, from the
brachial [...]
