Cardiology Coding Alert
Capture Catheterization Codes
Question: Our cardiologist performed the procedure (abbreviated) below for a patient with existing grafts. She had dynamic T-wave changes in precordial leads. Cardiac enzymes were indeterminate. How should I report this using CPT®, ICD-9-CM, and ICD-10-CM?
Description of the Procedure
The right femoral artery was entered … Ascending aortic root pressures obtained … catheter advanced to LC ostium and multiple views of LCA obtained … The catheter was advanced in the RCA with multiple views obtained. The catheter was then advanced in the saphenous vein graft to the diagonal branch, the obtuse marginal branch, and LIMA, LAD, and multiple views of those vessels were obtained. … The catheter was … advanced to LV, baseline LV pressures obtained. Following this, left ventriculography was performed … Post left ventriculography pressures were then obtained as was a pullback pressure across the aortic valve …
Summary of Results
1. Elevated LV end-diastolic filling pressure, normal LV systolic function
2. Occluded native RC, LAD, and circumflex coronary arteries.
3. Widely patent saphenous vein graft to the RCA, obtuse marginal system, diagonal system.
4. Widely patent LIMA and LAD.
Texas Subscriber
Answer: For the procedure, you should report 93459-26 (Catheter placement in coronary artery[s] for coronary angiography, including intraprocedural injection[s] for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection[s] for left ventriculography, when performed, catheter placement[s] in bypass graft[s] [internal mammary, free arterial, venous grafts] with bypass graft angiography; Professional component).
This code includes all related catheter introduction and positioning, recording cardiac and vascular pressures, imaging the vessels and performing a left heart catheterization and left ventriculography.
For the diagnosis under ICD-9, report the native artery occlusion using 414.01 (Coronary atherosclerosis of native coronary artery) and the presence of the grafts using V45.81 (Postsurgical aortocoronary bypass status).
Under ICD-10, you’ll report I25.10 (Atherosclerotic heart disease of native coronary artery without angina pectoris) and Z95.1 (Presence of aortocoronary bypass graft).
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