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Cardiology Coding Alert

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Modifiers for Left Heart Cath With Imaging

Published on Mon Oct 27, 2003

Question: What codes should I use for a left heart catheterization with a selective coronary angiogram, ventriculogram, selective bilateral renals, and selective bilateral internal carotids? Our cardiologist performed the entire procedure in the hospital's heart catheterization lab.

New Jersey Subscriber

Answer: For the left heart catheterization, you should report 93510-26 (Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous; professional component). Submit 93543 (Injection procedure during cardiac catheterization; for selective left ventricular or left atrial angiography) for the ventricular and atrial injection and 93545 for selective coronary angiography.
 
Use 93555-26 (Imaging supervision, interpretation and report for injection procedure[s] during cardiac catheterization; ventricular and/or atrial angiography) for the physician's radiological supervision and interpretation. For the selective coronary angiography, report 93556-26 (... pulmonary angiography, aortography, and/or selective coronary angiography including venous bypass grafts and arterial conduits).
 
Report 36245-50-51 (Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower- extremity artery branch; bilateral procedure; multiple procedures) for the selective catheter placement in the renals. Append modifier -50 to indicate that the procedure was bilateral and modifier -51 to indicate that the procedure is additional to the primary procedure.
 
For the bilateral renal angiography, report 75724-26 (Angiography, renal, bilateral, selective ... radiological supervision and interpretation).
 
Use 36216-51-LT (Selective catheter placement, arterial system; initial second-order thoracic or brachiocephalic branch; left side) for the selective catheterization in the left internal carotids and append -51 to indicate that this procedure is an additional service. Report 36217-RT (... initial third-order or more selective thoracic or brachiocephalic branch; right side) for the selective catheterization of the right internal carotids.
 
For the angiography performed in the internal carotids, you would need to add 75671-26 (Angiography, carotid, cerebral, bilateral, radiological supervision and interpretation). Depending on carrier guidance, you may need to list the bilateral renal catheterization on two lines with the same code, with or without modifier -50, as appropriate. Some carriers do not accept modifier -51 and require you to use modifier -59 (Distinct procedural service) in its place. Check with your carrier to confirm the preferred format.
 
You should list first on the claim form the three procedural codes that are not modifier -51 exempt in descending order, according to relative value units. Specifically, you should list 36217 (8.83 RVUs) first, 36216-51-LT (7.33 RVUs) second, and 36245-50-51 (6.60 RVUs) third. You should also list the remaining codes in descending order, but that is not as critical as listing in descending order the codes that are not modifier -51 exempt.

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