Cardiology Coding Alert

Question: My cardiologist's documentation indicates "right heart catheterization and cardiac output by the thermodilution technique." She used a right femoral access and advanced a Swan-Ganz catheter under fluoro to the right atrium, recorded pressures, and then moved to the right ventricular cavity and recorded pressures. She then manipulated the cath into the right pulmonary artery and pulmonary capillary wedge position recording pressures at both sites. After obtaining cardiac output, she removed the catheter. Should I report the right heart catheterization, cardiac output, and Swan-Ganz separately?

New Jersey Subscriber

Answer: Code 93501 (Right heart catheterization) covers all of the services you describe. Don't forget to append modifier 26 (Professional component) if you're reporting only the professional component.

CPT guidelines state that diagnostic cardiac catheterization includes:

• introduction, positioning, and repositioning of catheters

• recording intracardiac and intravascular pressure

• obtaining blood samples to measure blood gases or dilution curves

• cardiac output measurements.

Swan-Ganz: You should not report 93503 (Insertion and placement of flow directed catheter  [e.g., Swan-Ganz] for monitoring purposes) even though the physician specifically mentioned the same type of catheter referenced in the code description (Swan-Ganz). Reason: The cardiologist documented Swan-Ganz to describe the catheter she used to conduct the right heart cath. If she places the catheter, obtains measurements, and then withdraws the catheter you should report this as a right heart cath. If the cardiologist positions the catheter and leaves it in place for extended monitoring (hours vs. days), then you may consider 93503.

Cardiac output: You also shouldn't report 93561 (Indicator dilution studies such as dye or thermal dilution, including arterial and/or venous catheterization; with cardiac output measurement [separate procedure]) or 93562 (... subsequent measurement of cardiac output). CPT guidelines state that you should not report 93561 and 93562 with cardiac cath codes. The phrase "separate procedure" in the descriptor also indicates you shouldn't report the cardiac output codes unless the physician performs them independently of any other services performed that day.