jbhansen
Networker
I am scheduled to have a discussion with a physician regarding how LIMA angiography is to be billed when performed during a cardiac catheterization. I have been researching this issue and haven't been able to come up with a conclusive answer with firm back-up to support it.
The type of angiography in question is performed during a LHC in which coronary angiography reveals disease. In the likelihood the patient proceeds to having CABG, they perform a LIMA angiogram to evaluate whether the vessel will make a good bypass graft or not. These are most often performed selectively (cath in LIMA itself) but sometimes the catheter is only advanced into the left subclavian artery.
It is my understanding that code 93539 and S&I code 93556-26 would be used if the catheter is advanced selectively into the LIMA or the left subclavian (since that too is "selective").
However one could argue that 93539 is only for bypass grafts. I found the following from CPT Assistant, but it is a bit old and may be outdated:
Coding Consultation: Questions and Answers
CPT® Assistant October 2001 Volume 11 Issue 10
Question
I am unsure which structures the term "conduits" refers to in the descriptor for code 93539. Would you please explain this further?
AMA Comment
From a CPT coding perspective, the term "conduits" as used in code 93539, Injection procedure during cardiac catheterization; for selective opacification of arterial conduits (eg, internal mammary), whether native or used for bypass, refers to arterial bypass vessels. These "conduit" vessels would be present, for example, following a coronary artery bypass procedure.
One could argue that 36216 should be used if the LIMA is selectively catheterized (36215 if only the left subclavian is selected). The problem arises in that the S&I code 75756-26 is bundled with the cardiac catheterization codes and cannot be modified per NCCI. Would another S&I code (75650-26, 75710-26) be appropriate?
Any thoughts or sources that would back-up the use of either coding would be appreciated. I would like to have all my ducks in a row before my discussion. Thanks!
The type of angiography in question is performed during a LHC in which coronary angiography reveals disease. In the likelihood the patient proceeds to having CABG, they perform a LIMA angiogram to evaluate whether the vessel will make a good bypass graft or not. These are most often performed selectively (cath in LIMA itself) but sometimes the catheter is only advanced into the left subclavian artery.
It is my understanding that code 93539 and S&I code 93556-26 would be used if the catheter is advanced selectively into the LIMA or the left subclavian (since that too is "selective").
However one could argue that 93539 is only for bypass grafts. I found the following from CPT Assistant, but it is a bit old and may be outdated:
Coding Consultation: Questions and Answers
CPT® Assistant October 2001 Volume 11 Issue 10
Question
I am unsure which structures the term "conduits" refers to in the descriptor for code 93539. Would you please explain this further?
AMA Comment
From a CPT coding perspective, the term "conduits" as used in code 93539, Injection procedure during cardiac catheterization; for selective opacification of arterial conduits (eg, internal mammary), whether native or used for bypass, refers to arterial bypass vessels. These "conduit" vessels would be present, for example, following a coronary artery bypass procedure.
One could argue that 36216 should be used if the LIMA is selectively catheterized (36215 if only the left subclavian is selected). The problem arises in that the S&I code 75756-26 is bundled with the cardiac catheterization codes and cannot be modified per NCCI. Would another S&I code (75650-26, 75710-26) be appropriate?
Any thoughts or sources that would back-up the use of either coding would be appreciated. I would like to have all my ducks in a row before my discussion. Thanks!