Radiology Coding Alert

Check for catheterization, ventriculography, and angiography.

Cardiac catheterizations can be challenging if you haven’t read the details of what your physician actually did. Make sure you make note of which vessel or chamber your physician targets and the path to reach the target. Attempt this short quiz to assess your understanding of cardiac catheterizations.

Question 1: In a patient who presents with chest pain, your physician may do a left heart catheterization, left ventriculography, and coronary angiography? Which of the following codes do you submit when reporting these services?

a) 93459

b) 93452, 93454

c) 93458

d) 93457

Question 2: A patient presents to the cath lab for STEMI for coronary angiography. During the procedure, a drug eluting stent is placed in the left anterior descending coronary artery. How do you report this coronary intervention for outpatient hospital billing?

a) 92941

b) C9606

c) C9607

d) 92943

Question 3: How do you report when your physician does a combined right heart catheterization and transseptal left heart catheterization through intact septum for congenital cardiac anomalies?

a) 93532

b) 93533

c) 93530

d) 93531

Here are answers to the quiz you attempted for cardiac catheterizations.

Answer 1: The correct answer is c, 93458.

Your physician is doing a left heart catheterization, left ventriculography, and coronary angiography. All these services are inclusive in code 93458 (Catheter placement in coronary artery[s] for coronary angiography, including intraprocedural injection[s] for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection[s] for left ventriculography, when performed).

Codes 93452 (Left heart catheterization including intraprocedural injection[s] for left ventriculography, imaging supervision and interpretation, when performed) and 93454 (Catheter placement in coronary artery[s] for coronary angiography, including intraprocedural injection[s] for coronary angiography, imaging supervision and interpretation) apply to left heart catheterization and coronary angioplasty, respectively.

Code 93457 (Catheter placement in coronary artery[s] for coronary angiography, including intraprocedural injection[s] for coronary angiography, imaging supervision and interpretation; with catheter placement[s] in bypass graft[s] [internal mammary, free arterial, venous grafts] including intraprocedural injection[s] for bypass graft angiography and right heart catheterization) includes coronary angiography and bypass graft angiography. Code 93459 (Catheter placement in coronary artery[s] for coronary angiography, including intraprocedural injection[s] for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection[s] for left ventriculography, when performed, catheter placement[s] in bypass graft[s] [internal mammary, free arterial, venous grafts] with bypass graft angiography) includes left heart catheterization, left ventriculography, coronary angiography, and bypass graft angiography.

Answer 2: The correct answer is b, C9606.

Codes C9606 (Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel) and C9607 (Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel) are for drug-eluting stents. Since you are billing for outpatient services, your physician may be treating an acute case of myocardial infarction. You submit code C9606 for an acute total or subtotal coronary occlusion. For a chronic occlusion, you submit code C9607.

Codes 92941 (Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel) and 92943 (Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel) are not for drug-eluting stents.

Answer 3: The correct answer is a, 93532.

Since your physician is doing a combined right heart catheterization and transseptal left heart catheterization through intact septum, you submit code 93532 (Combined right heart catheterization and transseptal left heart catheterization through intact septum with or without retrograde left heart catheterization, for congenital cardiac anomalies).

Code 93530 (Right heart catheterization, for congenital cardiac anomalies) applies to right heart catheterization alone in cardiac anomalies and code 93531 (Combined right heart catheterization and retrograde left heart catheterization, for congenital cardiac anomalies) applies to right heart catheterization with retrograde left heart catheterization.

Code 93533 (Combined right heart catheterization and transseptal left heart catheterization through existing septal opening, with or without retrograde left heart catheterization, for congenital cardiac anomalies) applies to combined right heart catheterization and transseptal left heart catheterization through an existing opening in the septum.