Cardiology Compliance Question of the Week
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January 23, 2012
Question:
What codes should we be billing for a bubble study echocardiogram?
Answer:
A bubble study is coded the same as other echocardiograms: 93306 if complete with spectral Doppler and color Doppler, 99307 if complete without spectral and/or color, 93308 if limited. Some code an injection (96373 for instance) also, but many payers will not reimburse for the injection.
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January 16, 2012
Question:
Medicare guidelines state we cannot bill conscious sedation in additional to the heart cath codes. If during the procedure, a patient receives Nitroglycerin, Integrilin, etc. through an IV push or IV drip, can this be separately billed?
Answer:
From a Medicare perspective, the administration of drugs routinely used during a cardiac catheterization interventional procedure are bundled into the cardiac catheterization codes. The drugs can be billed separately with the appropriate J code.
For example, a left heart catheterization with coronary angiography is coded and billed with 93458. Medicare bundles codes 96374 and 96375 into code 93458; therefore, the injection or administration cannot be billed separately under current Medicare guidelines.
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January 9, 2012
Question:
My question relates to your December 19, 2011, question, which I have provided below my question.
Per coding guidelines, for pacemaker systems if one or more lead(s) are removed and the generator is replaced - whether ERI or any other reason at the same time, a new system insertion should be used. So wouldn’t the scenario described in the question be the same for an ICD system?
I believe it should be coded as 33249 – not as you recommend in your answer. We can’t change the guidelines that we follow for every other system replacement just to put the FB modifier on the lead insertion.
December 19
Question: Should we assign code 33249-FB (per CPT) or 33240 and 33216-FB for the following procedures: removal and replacement of an ICD generator (end of life); removal of fractured, recalled lead; and replacement of new lead at 100 percent cred, with evaluation under fluoro?
Answer: We would recommend codes 33240 (device) and 33216-FB. By coding this way, only the lead reimbursement is affected.
Answer:
You raise a good point for pacemaker procedures, but it appears the guidelines (edits) are different for ICD procedures (at least in 2011). Medicare did not issue an edit that prohibits the coding of codes 33240 and 33216 like they did for code 33213 and 33216. We are not sure if this is an oversight. However the guideline you refer to only mentions pacemakers so perhaps it was Medicare’s intent to allow for ICD procedures.
In the case covered in the December 19 compliance question, only the lead was affected by recall and modifier FB is assigned; Medicare reduces payment based on the vendor’s recall. If FB was assigned to code 33249, the hospital is out a great deal of money even though they bought the ICD device out right ($30,000), and the ICD was not related to the recall.
Therefore, to insure your facility receives proper reimbursement for the device and a reduction or no payment for the lead we are recommending codes 33240 and 33216-FB be reported. We think the edits will change in 2012 to account for the new definitions in CPT 2012.
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January 2, 2012
Question:
When we report codes for the replacement of a ventricular assist device (VAD), may we also report separately the device removal?
Answer:
According to the 2012 CPT coding manual, codes 33977, 33978, 33980 (removal of the VAD system being replaced) is not separately reportable. Report the replacement of the entire VAD with the insertion codes (33975, 33976, 33979).
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December 26, 2011
Question:
Is it appropriate to bill 76377 with 75561 (cardiac MRI)? I cannot find anything documented about the 3D with these studies.
Answer:
No, you cannot bill 3D with this code. Look in the CPT book under 76377 where there is a list of codes that cannot be reported with 76377.
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December 19, 2011
Question:
Should we assign code 33249-FB (per CPT) or 33240 and 33216-FB for the following procedures: removal and replacement of an ICD generator (end of life); removal of fractured, recalled lead; and replacement of new lead at 100 percent cred, with evaluation under fluoro?
Answer:
We would recommend codes 33240 (device) and 33216-FB. By coding this way, only the lead reimbursement is affected.
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December 12, 2011
Question:
We performed drainage of a myocardial effusion under CT guidance. What code would we assign?
Answer:
For pericardiocentesis, assign 33010, and for CT guidance, assign 77012.
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December 5, 2011
Question:
Must one session of CPT code 93798 (physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring [per session]) be a minimum of 60 minutes if only one session is provided that day?
Answer:
Here’s the guidance given by the Centers for Medicare & Medicaid Services:
No, if a hospital provides and bills for only one session of cardiac rehabilitation services (using either 93797 or 93798) for a patient in a given day, that session does not have to be a minimum of 60 minutes. However, because Medicare only covers a limited number of sessions for a beneficiary according to national coverage policy, CMS expects that hospitals will carefully plan a Medicare beneficiary’s cardiac rehabilitation so that the patient receives the anticipated benefit from the services.
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November 28, 2011
Question:
Is code 92973 the appropriate code for aspiration of a thrombus within a coronary vessel?
Answer:
Code 92973 should not be reported for aspiration of a thrombus. It should only be used when “mechanical fragmentation of the thrombus” is performed, according to the 2011 CPT® Reference Guide for Cardiovascular Coding (published by the American Medical Association and the American College of Cardiology Foundation).
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November 21, 2011
Question:
When we report codes for the replacement of a ventricular assist device, may we also report separately the device removal?
Answer:
According to the 2012 CPT coding manual, codes 33977, 33978, 33980 (removal of the VAD system being replaced) are not separately reportable. Report the replacement of the entire VAD with the insertion codes (33975, 33976, 33979).
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November 14, 2011
Question:
What do you recommend for setting fees for the chargemaster for the multiple procedures that are rolled up into one code?
Answer:
Work with your finance department to insure the change results in a budget neutral position.
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November 7, 2011
Question:
Does Medicare cover percutaneous transluminal angioplasty (PTA) with stenting of intracranial arteries for the treatment of cerebral arterial stenosis?
Answer:
Effective November 6, 2006, Medicare covers PTA and stenting of intracranial arteries for the treatment of cerebral artery stenosis ≥50% in patients with intracranial atherosclerotic disease as furnished in accordance with the Food and Drug Administration (FDA) approved protocols governing Category B investigational device exemption (IDE) clinical trials. The Centers for Medicare & Medicaid Services determined that coverage of intracranial PTA and stenting is reasonable and necessary under these circumstances.
For more information on this, go to the following links: http://www.cms.hhs.gov/transmittals/downloads/R1147CP.pdf, http://www.cms.hs.gov/transmittals/downloads/R64NCD.pdf, and
http://www.cms.hs.gov/mlnmattersarticles/downloads/MM5432.pdf.
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October 31, 2011
Question:
Can we use CPT code 93463 in conjunction with a FFR charge if an IV adenosine drip is used?
Answer:
Code 93463 is specific to the administration of a medication when the hemodynamic response is recorded before and after. It is not intended for medication administration during or prior to a coronary intervention. Refer to CPT instructional notes for clarification.
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October 24, 2011
Question:
My question relates to the following scenario. We did a heart cath with stent one day. The patient returned two days later, and we stented another artery (went directly to the intervention) and then injected the stent placed two days prior. Can we charge for a coronary angio done on the previous stent?
Answer:
If there was a change in the patient’s signs and symptoms that provided medical necessity to perform the angiogram, you could code the second coronary angiography.
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October 17, 2011
Question:
Can you explain how “single vessel” is defined? Do diagonal vessels off of the LAD or obtuse marginals off of the circumflex count as two vessels or a single vessel? What about when one or more grafts are injected? How is that coded?
Answer:
CPT describes a single vessel as being the main vessel and its branches. Therefore, the diagonal vessels and the LAD are considered one vessel.
One code should be assigned regardless of the number of grafts injected.
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October 10, 2011
Question:
If we perform a staged intervention in the same hospital admission, can we charge for coronary-only angio if we look at the previously stented vessel?
Answer:
The second coronary angiography would be coded only if there was a change in the patient’s signs and symptoms that provided medical necessity to perform the angiogram.
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October 3, 2011
Question:
A hospital near ours indicated that when coding and billing for a left heart catheterization (LHC) with coronary angiography it reports the following codes. Are these the correct choices?
93452 Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed
93454 Catheter placement in coronary artery(s) for coronary angiography, includingintraprocedural injection(s) for coronary angiography, imaging supervision and interpretation
Answer:
No, these are not the correct choices.
In CPT 2011, the American Medical Association (AMA) collapsed CPT codes so only one for non-congenital heart catheterizations is reported. The following should be reported for LHC with coronary angiography:
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
For more on this, see the 2011 CPT Manual, Cardiac Catheterization section.
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September 26, 2011
Question:
If a staged coronary stent is done, then the physician does the diagnostic cath, is there a global period to report for the cath?
Answer:
Currently, there is no global period for cardiac catheterization.
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September 19, 2011
Question:
Is cardioversion chargeable with an electrophysiology (EP) study w/ablation? We could not get the patient out of atrial fibrillation no matter how much was ablated, so we then cardioverted to prevent thrombus formation. I was told that you can’t charge for a cardioversion unless it is the only thing that was scheduled; otherwise, it is considered part of the diagnostic study and ablation procedure.
Answer:
You are correct. Cardioversion is consider integral to an EP study and is not coded separately if the cardioversion was performed in the same session as the EP study.
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September 12, 2011
Question:
Our providers perform an electrocardiogram (EKG) during an office visit on the same date of service as an in-person pacemaker check, usually to follow heart failure or atrial fibrillation overload. We are receiving bundling denials. Can you help resolve this?
Answer:
The National Correct Coding Initiative (NCCI) includes edits that preclude billing an EKG at the same visit as a pacemaker check. The pacemaker check includes EKG monitoring, so unless the EKG is separate from that it shouldn’t be coded. If it is a separate EKG, then you can bill it with modifier 59, but you’ll also have to check the local coverage determination (LCD) medical policy to see whether there are specific diagnoses required. Documentation would need to be clear in the medical record that it is a separate EKG.
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September 5, 2011
Question:
For aortic root with coronary arteries/saphenous vein graft (SVG), do we get an add-on code for supraventricular aortography?
Answer:
Yes, if medical necessity supports its assignment (for example, to evaluate the aortic valve). If the aortic root injection is performed to find the location of the SVG, then code 93567 should not be coded as this would be considered a road map.
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August 29, 2011
Question:
A hospital near ours indicated that when coding and billing for a left heart catheterization (LHC) with coronary angiography it reports codes 93452 and 93454. Are these the correct choices?
Answer:
No, these are not the correct choices.
In CPT 2011, the American Medical Association (AMA) collapsed CPT codes so providers report only one for non-congenital heart catheterizations. The following should be reported for LHC with coronary angiography:
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
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August 22, 2011
Question:
As a follow-up to the August 15 question and answer, can you please clarify the issue with billing blood gases during a heart cath? Our hospital bills for blood gases during a heart cath, but a recent auditor is challenging them for the following reasons:
- Cardiac Catheterization Guidelines: Right heart catheterization includes...obtaining blood samples for measurement of blood gases, and cardiac output measurements (Fick or other method).
- The Hospital Chargemaster Guide 2010 states: "..........unbundled cardiac catheterization services. Hospitals have separated out the costs of doing the procedure, such as extra time spent, extra film used, or charging separately for blood gas procedures from the actual procedure and assigned codes to them. However, Medicare considers these costs as overhead, which means that they are included in the payment for the procedure and are not reimbursed separately. These services should not be billed separately either."
Answer:
The first reference for the statement made by the auditor is not identified, and we can’t find similar wording in instructions from the Centers for Medicare & Medicaid Services. It is true that many services, medical devices and pharmaceuticals are packaged into the primary procedure and not billed separately.
MedLearn uses the National Correct Code Initiative (NCCI) edits, which are published quarterly, to determine what services Medicare packages or bundles together. According to version 17.1 of the NCCI edits, there is no edit that prohibits the provider from billing the testing of a blood gas sample (code 82803) with a right heart catheterization procedure (e.g., code 93451).
Perhaps the auditor is stating a corporate or hospital policy. It is important to remember that the right heart catheterization codes include the obtaining of the sample but not the testing!
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August 15, 2011
Question:
Is it appropriate to charge for blood gases in conjunction with a cardiac cath? The blood gases are not in relation to anesthesia, rather, they are requested by the cardiologist with medical necessity.
Answer:
It would be appropriate to code for blood-gas analysis with heart catheterization. Code 82803 is the code to consider. Insure the laboratory compliance mandates are observed if the sample is analyzed with equipment in the lab.
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August 8, 2011
Question:
What are the Category III CPT codes you mentioned last week to report optical coherence tomography?
Answer:
As stated in last week’s answer, optical coherence tomography is currently being reported using code 93799 (unlisted cardiovascular service or procedure). On January 1, 2012, the following codes will be implemented:
0291T - Intravascular optical coherence tomography (coronary native vessel or graft) during diagnostic evaluation and/or therapeutic intervention, including imaging supervision, interpretation, and report; initial vessel (List separately in addition to primary procedure)
0292T - each additional vessel (List separately in addition to primary procedure)
The American Medical Association’s instructions indicate that these codes will be used in conjunction with cardiac catheterization codes 92975, 92980, 92982, 92995, 93454–93461, and 93530–93533 (when angiography is additionally performed and reported with 93563, 93564). Intravascular optical coherence tomography services include all transducer manipulations and repositioning within the specific vessel being examined, both before and after therapeutic intervention (e.g., stent placement).
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August 1, 2011
Question:
During a diagnostic and therapeutic cardiac catheterization procedure, selective coronary angiography was performed as well as insertion and removal of an intra-aortic balloon pump (IABP). Optical coherence tomography was performed to determine clot burden of the LAD/ramus intermedius. In addition to the diagnostic coronary angiography, how
would we code for the performance of the IABP placement and subsequent removal (same clinical setting) as well as the optical coherence tomography?
Answer:
From a CPT coding perspective, it would be appropriate to report both the IABP insertion and removal on the same day using codes 33967 (insertion of IAB assist device, percutaneous) and 33968 (removal of IAB assist device, percutaneous).
The cardiac catheterization with selective coronary angiography may also be reported with 93454 (catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation).
Currently, the optical coherence tomography is reported using code 93799 (unlisted cardiovascular service or procedure). However, the American Medical Association released two new Category III CPT codes on July 1 that will be implemented on January 1, 2012.
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July 25, 2011
Question:
Is it appropriate to charge for blood gases in conjunction with a cardiac cath? The blood gases are not in relation to anesthesia, rather, they are requested by the cardiologist with medical necessity.
Answer:
It would be appropriate to code for blood-gas analysis with heart catheterization. Code 82803 is the code to consider. Insure the laboratory compliance mandates are observed if the sample is analyzed with equipment in the lab.
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July 18, 2011
Question:
I read with interest the answer to the July 4 Cardiology Question, which says to assign code 75625 when the procedure represented by 93567 is done with a heart cath. In CPT 2011, parenthetical instructions just prior to code 93561 mention that “injection procedure codes 93563–93568 include imaging supervision, interpretation, and report.” It would seem to me that 75625 should not be coded with 93567 and a heart cath. Please comment.
Answer:
The intent of using BOTH of the codes would be if TWO separate procedures were performed, not routinely one with the other.
For example, if an abdominal aortogram (for example, for abdominal aortic aneurysm) was performed with a diagnostic LH cath and coronaries, then codes 93458 and 75625 would be submitted. If a diagnostic left HC and coronaries were performed with an accompanying aortic root or ascending aortogram, then codes 93458 and 93567 would be used.
If a diagnostic left HC and coronaries, abdominal aortogram(for example, for abdominal aortic aneurysm) and an a aortic root or ascending aortogram were performed, ONLY then would codes 93458, 75625 and 93567 be used.
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July 11, 2011
Question:
Would you please clarify your response to the 7/4/11 Cardiology Compliance question? You stated the following:
“When an abdominal aortography is performed at the same session as a cardiac catheterization, 75625 may be reported in addition to the appropriate cardiac catheterization code(s). The injection procedure and the radiological supervision and interpretation for the abdominal aortography are not inclusive components of cardiac catheterization codes 93451–93464, 93530–93533, and 93563–93568.
If no further selective catheterization was required (for example, the abdominal aortography was performed en route to the heart or during pull-back following the cardiac catheterization), it would not be appropriate to additionally report code 36200 (introduction of catheter, aorta) for the selective catheterization"
However, when I enter a cardiac cath code (like 93458) with 75625, it is a CCI edit per 3M. Under what circumstances is the abdominal aortogram allowed? Also, please indicate if and when selective renals are allowed with a cardiac cath and the code used in this instance.
Answer:
Relative to the 3M CCI edit comment, the modifier indicator for codes 75625 and 93458 is “1,” meaning that if they are separate procedures, both codes may be assigned and modifier 59 is assigned to 75625.
A separate abdominal aortogram (75625-59 instead of the G codes for non-selective renals) could be allowed for a complete diagnostic study for non-renal abdominal indications, such as an abdominal aortic aneurysm.
Codes 36245 and 75722/75724 are assigned when selective renals are medically necessary and performed (with or without a heart cath). Payable medical necessity would be determined by individual payers.
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July 4, 2011
Question:
In the 2011 CPT code book, the following parenthetical note follows code 75625—aortography, abdominal, by serialography, radiological supervision and interpretation: (For injection procedure, use 93567, which includes imaging supervision, interpretation, and report.).
Does this mean that when an abdominal aortogram and a cardiac cath procedure are performed at the same time, both CPT 75625 and 93567 should be assigned? Is this still true if no imaging of the aortic root or ascending aorta has been performed?
Answer:
When an abdominal aortography is performed at the same session as a cardiac catheterization, 75625 may be reported in addition to the appropriate cardiac catheterization code(s). The injection procedure and the radiological supervision and interpretation for the abdominal aortography are not inclusive components of cardiac catheterization codes 93451–93464, 93530–93533, and 93563–93568.
If no further selective catheterization was required (for example, the abdominal aortography was performed en route to the heart or during pull-back following the cardiac catheterization), it would not be appropriate to additionally report code 36200 (introduction of catheter, aorta) for the selective catheterization.
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June 27, 2011
Question:
We have had some debate over when we can use the codes for IV injection initial (96374) and IV injection additional (96375). During a cardiac cath, when using moderate sedation (99144), we have used the IV injection codes for meds outside of routine meds given for the cath and/or PCI. We were just told that we cannot use any in the IV injection codes during a case that we are charging moderate sedation or recovery (75038 or 75047). Can you provide guidance on this?
Answer:
Medicare guidelines state that moderate sedation cannot be billed in addition to the heart cath codes because it is included within those codes. In the CPT code book, a bulls-eye symbol appears in front of a code to indicate that moderate sedation is included within the procedure described. In regards to injection codes 96374 or 96375, Medicare edits do not allow the aforementioned codes to be billed with the heart cath codes.
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June 20, 2011
Question:
For aortic root with CORS/SVG, do we get an add-on code for supraventricular aortography?
Answer:
Yes, if there is medical necessity to assign it (for example, to evaluate the aortic valve). If the aortic root injection is performed to find the location of the SVG, then code 93567 should not be coded as this would be considered a road map.
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June 13, 2011
Question:
I came across an echo that was actually a 3D echo. Is this something we may be seeing more of? Would the unlisted code 93799 be used? Or could 76376 or 76377 be used?
Answer:
Code 76376 would be reported in addition to the echo code.
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June 6, 2011
Question:
If a physician uses a foramen ovale to cross the intra-atrial septum during an EP study and probes the foramen ovale with a transseptal needle, does this qualify to be coded as 93462, even though this is not a transseptal puncture through an intact septum?
Answer:
A foramen ovale is an opening between the two atriums of the heart. In most people, it closes at birth or shortly after. Therefore, based on currently available resources for CPT, it appears that it would be inappropriate to report code 93462 when the foramen ovale is used in lieu of an intact septum as the code descriptor requires.
May 30, 2011
Question:
*Previous Question/Answer: When using a thrombectomy catheter during percutaneous cardiac intervention (PCI), can 92973 be assigned when a manual extraction catheter such as the Pronto or Quick-Cat is used?
Answer: Yes, code 92973 can be used regardless of the method of thrombectomy.
Answer:
*Further explanation of above answer: In a previous question regarding the use of an extraction catheter (e.g. for aspiration of clot), MedLearn indicated that code 92973 would be the appropriate code for an aspiration thrombectomy. Recently the American Medical Association (AMA) and the American College of Cardiology (ACC) released new information that revises this answer. In their CPT Reference Guide for Cardiovascular Coding, they state the following:
"Code 92973 is used to report mechanical thrombectomy using an Angiojet or similar catheter that mechanically fragments and removes clots. Other procedures using catheters (e.g. pronto, Fetch) that aspirate thrombus but do not mechanically fragment thrombus are not reportable with codes 92973."
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May 23, 2011
Question:
How would you code the following? The physician performs an EP study with three catheters: one placed around the tricuspid valve annulus and just into the coronary sinus, one placed in the right ventricular apex, and the other in the region of the His bundle. The physician also performs His bundle recording, recording and pacing of the right ventricle, recording and pacing of the right atrium from the proximal coronary sinus, and attempted induction of arrhythmia.
Answer:
Based on the information provided we would recommend the following code:
93620 - Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, his bundle recording
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May 16, 2011
Question:
Must one session of CPT code 93798 (physician services for cardiac rehabilitation, with continuous ECG monitoring [per session]) be a minimum of 60 minutes if only one session is provided that day?
Answer:
No, if a hospital provides and bills for only one session of cardiac rehabilitation services (using either CPT code 93797 or CPT code 93798) for a patient in a given day; that session does not have to be a minimum of 60 minutes. However, because Medicare only covers a limited number of sessions for a beneficiary according to national coverage policy, the Centers for Medicare & Medicaid Services (CMS) says that it expects that hospitals will carefully plan a Medicare beneficiary’s cardiac rehabilitation so that the patient receives the anticipated benefit from the services.
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May 9, 2011
Question:
Do you absolutely have to cross the valve to call it a left heart cath?
Answer:
Yes. In a left heart catheterization, a catheter crosses the aortic valve into the left chambers of the heart for the purpose of evaluating pressures, obtaining blood samples or performing a left ventriculography. If the catheter does not cross the aortic valve, it is not considered a left heart catheterization.
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May 2, 2011
Question:
How do I code the following: coronaries and LV pressures are performed, but NO LV gram?
Answer:
For the procedure you describe, the following would be the appropriate 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
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April 25, 2011
Question:
Can you explain how new code 93565 should be used?
Answer:
The description of code 93565 defines exactly when it should be used. It reads as follows: injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective left ventricular or left atrial angiography. (List separately in addition to code for primary procedure.) The parenthetical notes following code 93565 in the CPT code book indicate that it should not be reported in conjunction with 93452–93461 but that it may be used with 93530–93533.
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April 18, 2011
Question:
Is it appropriate to assign code 93452 when coronary angiography is performed?
Answer:
No, this code description does not include the performance on a coronary angiography. Code 93452 is for a left heart cath w/wo left ventriculography only.
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April 11, 2011
Question:
Based on the documentation below, is it appropriate to bill 75710-26 in addition to a heart cath?
VASCULAR ANGIOGRAPHY SUMMARY: The left subclavian artery and the left internal mammary artery were visualized by selective angiography. Angiography displayed no evidence of significant obstruction in the left internal mammary artery. The left subclavian artery is 60% obstructed by a single discrete lesion. 60-70% proximal left subcalvian "kink" prior to the take-off of the LIMA, which appears large in size, exhibiting normal flow and is suitable for use as a bypass conduit if needed.
Answer:
Because there is a discrete lesion in the subclavian, it would be appropriate to assign code 75710-59-26 for the angiogram of the subclavian. However, if the angiogram of the subclavian was merely performed to locate the origin of the internal mammary artery, it would not be coded because it would be considered road-mapping. It would be assigned in addition to new 2011 code 93458 or 93459.
MedLearn has submitted a question to the American Medical Association regarding the appropriateness of code 93459 over 93458 when the internal mammary is evaluated for a potential graft via an actual graft. We are awaiting the AMA's response.
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April 4, 2011
Question:
If you measure AO pressure AND perform coronary angiography, would this be considered coronary artery catheterization and angiography only or would this be considered a left heart cath with/without left ventriculography?
Answer:
The procedures you described would be coronary catheterization only and code 93454 would be assigned because the aortic valve was not crossed.
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March 28, 2011
Question:
Can you provide guidelines related to the type of exercise that meets the criteria for billing new code 93464?
Answer:
In 2011, the American Medical Association revised the cardiac catheterization section of CPT, and it established codes 93451–93464 to report diagnostic cardiac catheterization. Add-on code 93464 describes physiologic exercise study performed in conjunction with cardiac catheterization, and the AMA includes “bicycle or arm ergometry” as examples of that exercise in the code description. Report this code once per catheterization along with codes 93451-93453, 93456-93461, and 93530-93533.
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March 21, 2011
Question:
This is a follow-up question to your March 14 response related to the fact that moderate sedation is not billed separately for the cardiac cath procedures. What about recovery charges (complex and standard, such as PACU charges)?
Answer:
Under the Medicare outpatient perspective payment system, post-recovery charges are not reimbursed separately but included in the reimbursement for the procedures performed. If the patient is an inpatient, the recovery charges are included within the DRG payment.
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March 14, 2011
Question:
For cardiac cath procedures, what is the code for moderate sedation?
Answer:
Moderate sedation is inclusive of cardiac catheterization procedures and is not billed separately.
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March 7, 2011
Question:
In 2010, when SVG angio and the AO root angio were performed together, if the SVG was selected we could not bill the AO root. Has this changed in 2011?
Answer:
It the aortic root was performed to evaluate the aortic valve, it is separately billable from the SVG evaluation. However, if the aortic root injection is performed to locate the SVG, the aortic root injection is considered a road map and not separately billable.
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February 28, 2011
Question:
When is it appropriate to use CPT code 93624?
Answer:
The most common use of 93624 is in the following situation:
Recording and pacing is performed in one or two sites within the heart followed by the administration if Isoprul and ablation for SVT. Because add-on code 93623 (programmed stimulation and pacing after intravenous drug infusion) is reportable only in conjunction with 93619 and 93620, code 93624 (electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia) is reported to describe follow-up electrophysiologic study of the efficacy of any therapy undertaken, including any therapy initiated, whether pharmacologic, surgical, or catheter ablation, or device therapy.
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February 21, 2011
Question:
When we performed a heart cath in 2010, we could also bill 93539 for viewing a native IMA as a potential graft vessel because CPT specified "whether native or used for bypass." In 2011, 93539 was deleted, and CPT code 93459 does not include the term "native." Should we assign 93459 when a left heart cath is performed and the native IMA is injected to asses patency as a potential graft vessel?
Answer:
Neither the American Medical Association nor the Centers for Medicare & Medicaid Services have provided a directive on how to code this. Currently, MedLearn is recommending that code 93459 be assigned for the imaging of the coronary and IMA as a potential graft. Please note that all of the new heart cath codes are reimbursed at the same amount, which leads us to believe that the example provided was given consideration by CMS in reimbursement and, therefore, no separate code was issued.
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February 14, 2011
Question:
My question relates to your January 24 coding question and answer. Don’t code 93458 and 93460 include a LV gram? Can you clarify this?
Answer:
The key wording in the descriptions is "when performed." It is no longer a mandate that a left venticulargram be performed to bill the codes 93458 or 93460.
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February 7, 2011
Question:
In 2010, when performing a heart cath, we could also bill 93539 for viewing a native IMA as a potential graft vessel because CPT specified "whether native or used for bypass." In 2011, CPT code 93459 does not include the term "native." Should procedure 93459 be used when a left heart cath is performed and the native IMA is injected to assess patency as a potential graft vessel?
Answer:
Neither the American Medical Association nor the Centers for Medicare & Medicaid Services has provided a directive on how to code this. We are currently recommending that code 93459 be assigned for the imaging of the coronary and IMA as a potential graft. Please note that all of the new heart cath codes are reimbursed at the same amount leaving us to believe that the example provided was given consideration by CMS in reimbursement and therefore no separate code was issued.
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January 31, 2011
Question:
Historically, we could report IMA imaging with a heart cath whether it was used as a graft or native. With the inception of new codes 93455, 93457, 93459, and 93461, is that still true?
Answer:
In 2011, the imaging of the IMA is now collapsed into the codes you have listed in the question. There is not a specific code anymore for catheterization and imaging only of the IMA. MedLearn recommends that if only the IMA is imaged (and the coronary arteries are not), code 93455 with modifier 52 should be reported.
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January 24, 2011
Question:
I am looking for guidance to confirm if I am choosing the correct CPT code for the following scenario for 2011: left heart (LV) pressure, coronary injection(s) and S&I, no LV gram.
I believe that 93458 is the best fit. Can you confirm? If the scenario above is performed with a right heart cath, is 93460 the CPT to choose?
Answer:
Yes, your code choices are correct.
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January 17, 2011
Question:
I would like to know whether the closure-device procedure can be used in heart caths or peripherals.
Answer:
Closure devices cannot be billed with diagnostic catheterization and with lower extremity interventions. Based on current CPT language, the closure device may be coded and billed separately with other procedures.