Cardiology Coding Alert

Question: How should I code all the parts of this procedure? My cardiologist performed:
  left heart catheterization
  left coronary angiography
  left ventriculography
  venous graft angiography
  internal mammary and aortic arch angiography
  iliac artery angiography (so the doctor can place a perclose closure device).


Missouri Subscriber


Answer: Assuming your cardiologist's record supports a full left heart catheterization with venous and internal mammary imaging, you should report:
  93510-26 - Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous; professional component
  93539 - Injection procedure during cardiac catheterization; for selective opacification of arterial conduits (e.g., internal mammary), whether native or used for bypass
  93540 - ...for selective opacification of aortocoronary venous bypass grafts, one or more coronary arteries
  93543 - ...for selective left ventricular or left atrial angiography
  93544 - ...for aortography
  93545 - ...for selective coronary angiography (injection of radiopaque material may be by hand)
  93555-26- Imaging supervision, interpretation and report for injection procedure(s) during cardiac catheterization; ventricular and/or atrial angiography; professional component
  93556-26- ...pulmonary angiography, aortography, and/or selective coronary 
angiography including venous bypass grafts and arterial conduits (whether native or used in bypass); professional component. You should not bill for the iliac angiography when a cardiologist performs it for closure device placement. This is because the angiography conducts imaging to provide guidance for a service that is not covered/integral to the heart catheterization.

Red flag: Similarly, you may not be able to separately report the aortic arch angiography (93544). If the cardiologist visualized the aortic arch to provide guidance for selective catheterization of the venous graft or a roadmap for the internal mammary artery, you cannot separately bill this service.

Code 93544 represents a diagnostic study of the aortic arch. To bill 93544, you have to have medical necessity to visualize this area. Your cardiologist's report must reflect the diagnostic nature and findings of the study.