Cardiology Coding Alert

Question: My cardiologist placed an arterial line for continuous blood pressure monitoring during a left heart catheterization (93452)? Which code should I report? My first thought was 36556. Is this correct?

Texas Subscriber

Answer: No. Code 36556 (Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older) is reserved for catheter placement and pressure monitoring in a major vein. Instead, you should look toward code 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous) to report the blood pressure monitoring portion of the right heart catheterization.

However, before doing so, you’ll want to confirm that the operative report documents two separate access points for the placement of for the heart catheterization and blood pressure monitoring catheters. For example, consider the following scenario: The surgeon places a 7 French sheath into the left femoral vein and a 4 French sheath into the left femoral artery for blood pressure monitoring. The surgeon proceeds to perform a left heart catheterization.

In this example, you’ve got two separate access points, with the blood pressure monitoring access point being through the left femoral artery. You’ll report 36620 with modifier 59 (Distinct Procedural Service) or XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure), alongside code 93452 (Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed).