Tricks of the Cardiology Cath Trade:
How to Optimize Reimbursement and Decrease Denials
Published on Sat May 01, 1999
Editors note: Five years ago, the CPT editorial panel adopted an entirely new coding system for cardiac catheterizations and angiograms that unbundled previous codes. Today, in order to report the complete procedure, coders must correctly select component codes from three different ranges.
Despite the CPTs unbundling of caths/angiograms, coding for these procedures continues to be confusing, for beginning and experienced coders alike.
A common misconception is that because the codes have been unbundled, every injection and every S&I [imaging, supervision and interpretation] can be billed for. Thats just not true, warns Sueanne Bicknell, RRA, CCS-P, reimbursement and compliance specialist at Cardiovascular Provider Resources-Heart Place in Dallas, TX.
But undercoding is also a problem, she points out. Another mistake is to fail to bill for one or both of the S&I codes, she adds. If the cardiologist is doing injections, 90 percent of the time he or she is also doing supervision and interpretation of these injections, so you should bill for them or you are throwing revenue out the window.
Bicknell uses this step-by-step approach to teach the cardiac catheterization/angiography series to her coding staff:
1. The cardiologist places the cath (93501-93533). In a typical cath procedure, local anesthesia and appropriate sedation is used to insert the cath through a vein or an artery, depending upon whether its a right or left heart catheterization. The catheter may be inserted by cut-downan incision of skin and the artery or veinor percutaneous technique through the femoral, brachial or axillary artery. The type of percutaneous technique does not affect coding, Bicknell explains.
Although the patients recovery time may be reduced when a left heart cath is performed through the brachial artery instead of the femoral one, payers dont care. The code should still be 93510, because the CPT description says the procedure may be performed from the brachial, axillary or femoral artery, she says.
Next, the cardiologist, with fluoroscopic guidance, advances the catheter through the circulatory system into the heart. However, you cant bill for fluoroscopic guidance (76000) with a cath/angiogram because it is considered an inherent portion of the procedure.
Likewise, you also would not bill for the following:
introduction, positioning, and, when necessary, repositioning of the catheter(s);
obtaining blood samples to measure blood gases and/or dye or other dilution curves;
measuring cardiac output;
recording of intracardiac and intravascular pressure; and
final evaluation and report of procedures.
However, you can bill for an EKG (93000-93010) prior to the cath/angiogram if the result from the test is the reason the cardiologist made the decision for doing the cath. Some carriers may require modifier -59 (separate significant services) to be added to the EKG code.
To bill a placement code (93501-93533), first study the documentation to find out what was [...]
