Pulmonology Coding Alert

Question: If a patient undergoes the insertion of a Swan-Ganz catheter introducer into a central vein followed by the floatation of a Swan-Ganz catheter, should two billing codes be used, or are both procedures implied within the Swan-Ganz catheter code?

Philadelphia Subscriber

Answer: According to CPT 2000, cardiac catheterization is a diagnostic medical procedure which includes introduction, positioning and repositioning of catheter(s), when necessary, recording of intracardiac and intravascular pressure, obtaining blood samples for measurement of blood gases or dilution curves and cardiac output measurements with or without electrode catheter placement, final evaluation and report of procedure. This implies that code 93503 (insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes) includes the insertion of the Swan-Ganz into a central vein.