Cardiology Coding Alert

Question: How should I report a right heart catheterization with heart biopsy? The patient, who has trisomy 21, had a heart transplant, and the biopsy is performed each year.

Codify Member

Answer: For the heart biopsy, report 93505 (Endomyocardial biopsy). Append modifier 26 (Professional component) to 93505 if you’re reporting only the physician’s work.

If the catheterization was performed only to complete the biopsy, you should not report the cath separately. But if the catheterization was a complete diagnostic catheterization, report 93451 (Right heart catheterization including measurement[s] of oxygen saturation and cardiac output, when performed). Append modifier 26 (Professional component) if you’re reporting only the physician’s work. Also append modifier 59 (Distinct procedural service) to 93451 to show it’s distinct from the biopsy. Correct Coding Initiative (CCI) edits bundle 93451 into 93505, but you may override the edit when appropriate.

You should report V58.44 (Aftercare following organ transplant) and V42.1 (Heart replaced by transplant). If documentation shows the physician took the trisomy 21 into account in determining patient treatment and management, you may also report 758.0 (Down’s syndrome).