Radiology Coding Alert

Question: Our physician performed a coronary angiogram and the procedure is described here below. This procedure was done for a patient with existing grafts who had suggestive ECG changes and the cardiac enzymes were indeterminate.

Description of the procedure: “The right femoral artery was entered … Ascending aortic root pressures obtained … catheter advanced to LC ostium and multiple views of LCA obtained … The catheter was advanced in the RCA with multiple views obtained. The catheter was then advanced in the saphenous vein graft to the diagonal branch, the obtuse marginal branch, and LIMA, LAD, and multiple views of those vessels were obtained. … The catheter was … advanced to LV, baseline LV pressures obtained. Following this, left ventriculography was performed … Post left ventriculography pressures were then obtained as was a pullback pressure across the aortic valve …”

During this procedure, our physician documented an elevated LV end-diastolic filling pressure and normal LV systolic function. There was occlusion in the native right coronary (RC), left anterior descending (LAD), and circumflex coronary arteries. The existing saphenous venous grafts to the RCA, obtuse marginal system, diagonal system were widely patent, so were the LIMA and LAD. How should we report this procedure and the diagnosis?

Texas Subscriber

Answer: For the procedure described here, you should report 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) and append modifier 26 (Professional component) for the professional component.

This code includes the following: 

• Introduction and positioning of the catheter

• Recording of the cardiac and vascular pressures

• Imaging of the vessels 

• Performing a left heart catheterization and left ventriculography.

Diagnosis codes (ICD-9): For the diagnosis under ICD-9, you report the native artery occlusion using 414.01 (Coronary atherosclerosis of native coronary artery) and the presence of the grafts using V45.81 (Postsurgical aortocoronary bypass status).

ICD-10 options: When ICD-10 is implemented later this year, you’ll report I25.10 (Atherosclerotic heart disease of native coronary artery without angina pectoris) and Z95.1 (Presence of aortocoronary bypass graft).