Part B Insider (Multispecialty) Coding Alert

Question: We have documentation from the cardiologist's op report that states he performed a heart catheter and intervention procedure. He used the Seldinger technique to insert a guiding catheter into the right femoral artery. Here is a snippet of the op report:

"Positioned a guiding catheter into the left main artery where I performed initial injections in different projections, revealing a 90 percent occlusion of the circumflex artery and sub-total occlusion of the obtuse marginal branch. I attempted for several minutes to cross the obtuse marginal occlusion without success. At this point, I decided to proceed with angioplasty and stenting of the circumflex artery."
Should I report CPT 93510 in this case?


Kansas Subscriber

Answer: No, the op report doesn't support 93510 (Left heart catheterization, retrograde...) because your cardiologist did not state he advanced the catheter across the aortic valve.

A cardiologist typically uses percutaneous puncture to place an introducer sheath in the femoral artery (such as, Seldinger technique). He advances an angiography catheter through the sheath to the opening of the artery, conduit or venous coronary bypass (such as, "positioned guiding catheter into the left main artery"). Finally, the cardiologist injects contrast material or dye through the artery while recording a cineangiogram (such as, "I performed initial injections in different projections").

Do this: For these reasons, you should report 93508 (Catheter placement in the coronary artery[s] arterial coronary conduit[s]...). You should also report the following codes: 93545 (Injection procedure during cardiac catheterization...); 93556-26 (Imaging supervision, interpretation and report for injection procedure[s]...); and 92980 (Transcatheter placement of an intracoronary stent[s], percutaneous...).

Why: Always include an injection code (93545) with the left cath series. Understand that 93556-26 represents the supervision and interpretation in a facility setting, while 92980 represents the stenting of the circumflex artery. Note: Remember to add modifier 26 to 93508 also.