When You Should--and Should Not--Report Cath Codes
Published on Wed Sep 21, 2005
Tip: Treat intervention codes as a package deal You won't always report a diagnostic cath code in every interventional situation. Here's how to make your way through the planned and unplanned interventional procedure maze.
Example 1: Your cardiologist plans for and schedules a coronary interventional procedure (angioplasty, atherectomy or stent placement).
Answer: In this case, you should not report the cath placement (93508-93510) or any diagnostic imaging (such as, 93543, Injection procedure during cardiac catheterization; for selective left ventricular or left atrial angiography or 93545, ... for selective coronary angiography [injection of radiopaque material may be by hand]) at the time of the procedure.
Why? The intervention codes are package codes and include everything involved. In other words, "if your cardiologist knows where the blockage is but needs to inject dye to do the intervention, then he is establishing roadmaps, which aren't reimbursable," says Sandy Fuller, CPC, a compliance officer at Cardiovascular Associates of East Texas in Athens.
Example 2: A diagnostic catheterization leads to an urgent, unplanned intervention.
Answer: You can report the full diagnostic heart catheterization and the interventional codes and receive separate reimbursement, says Jim Collins, CPC, ACS-CA, CHCC, CEO of The Cardiology Coalition.
Medicare and other payers, however, commonly reduce the heart catheterization reimbursement (93510) by 50 percent when a cardiologist performs an intervention at the same time, Collins says. This reduction is controversial because CPT lists 93510 as modifier 51 exempt. In every other case, this exemption means that no multiple-procedure reduction applies, Collins says.
