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Answer: The key factor here is that the operative report did not mention whether the Swan-Ganz catheter remained in the patient for monitoring purposes when the patient was sent to the ICU. If the answer is "yes" (supported with documentation), the left heart catheterization (93510, left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous) could be billed with 93503 (insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes) because the catheter remains in the patient for monitoring purposes.
Although there is no code for combined left heart/right heart catheterization with monitoring, there is a code for combined left heart/right heart catheterization without monitoring. Often a right heart catheterization is performed, measurements are taken, and the catheter is removed. Had no other catheterization been performed, this procedure would have been coded 93501 (right heart catheterization). In this case, a left heart catheterization was also performed, so the correct code is 93526 (combined right heart catheterization and retrograde left heart catheterization).
Reference to a Swan-Ganz catheter in 93503 complicated this coding situation. Mere mention of a Swan-Ganz catheter being used does not mean that 93503 should be billed. In fact, the type of catheter used is not significant: Swan-Ganz or similar catheters are also used for right heart catheterizations without monitoring.
The American College of Cardiology makes it clear that "93503 is distinguished from code 93501 in that the service described by code 93503 is not typically performed in the cardiac catheterization laboratory. Placement of a flow-directed catheter for monitoring in an intensive care setting is done to monitor critically ill patients, or pre-operatively to allow monitoring of hemodynamics during surgery. The right heart catheterization, described by code 93501, is diagnostic in nature and often performed in conjunction with other cardiac catheterization procedures."
Given the failure to document any monitoring, the session should be coded 93526 with the appropriate injection and supervision and interpretation codes for the left heart catheterization. |
