Cardiology Coding Alert

Question: My cardiologist put the right femoral sheath in place and placed the right coronary catheter into the patient’s right coronary artery. Selective injections showed patency of the recently placed stents with moderate diffuse disease seen distally in the PDA, and posterolateral branch. The catheter was exchanged for a 4-French left 4-Judkins catheter and placed in the left coronary artery. Selective injections showed patency of the previously placed stent in the circumflex artery with good flow into the distal vessel and no change seen in the left main or more proximal LAD and subtotal ramus branch with a known total occluded LAD. Small earlier dissection was seen in the circumflex artery, but it appeared to be healing well with good flow. My cardiologist removed the catheter, and the patient was feeling improved. Findings showed a successful, stable picture of the right coronary artery stent with small distal vessels and successful PTCA stenting of the circumflex with a small stable dissection seen in the obtuse marginal rami. Left main disease, subtotal ramus, and occluded LAD was unchanged. What codes should I report on my claim?

North Carolina Subscriber

Answer: You should report 93454 (Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation) on your claim. In this procedure, the provider selectively placed a catheter in both the right and left coronary arteries and injections were made to visualize the arteries and their branches. If this coronary cath was performed with an intervention in the same session and meets CPT®’s requirements for reporting a diagnostic study, add modifier 59 (Distinct procedural service) to 93454.