Cardiology Coding Alert

Question: The cardiologist documented a "trans-septal puncture" procedure. What can you tell me about this procedure? Does it have its own code?

Ohio Subscriber

Answer: The cardiologist likely performed the procedure described by 93528 (Combined right heart catheterization with left ventricular puncture [with or without retrograde left heart catheterization]).    
 
During this procedure, the cardiologist performs a right heart catheterization through the femoral, subclavian, internal jugular or antecubital vein to the right atrium. He then passes the catheter through the tricuspid valve into the right ventricle and into the pulmonary arteries. This procedure is distinguished from other combined right and left heart catheterizations because the left heart catheterization involves puncturing the atrial septum to pass the catheter into the left ventricle.
 
Sometimes the physician will perform a separate left heart catheterization with a right heart catheterization. You would not bill this procedure separately because 93528 includes this service.
 
When billing 93528, you should also include the appropriate injection (93539-93545) and supervision and interpretation (93555-93556) codes. If the physician performs the left heart cath only through the septum, however, this is not also a retrograde cath placement. So you won't be able to bill coronary injections (93545) or aortic root injections (93544.)