Know How Guidelines Impact New Cardiac Cath Codes

This time, CPT 2011 brings major overhaul to cardiac catheterization coding. As a matter of fact, there are 19 deleted cardiac codes, 20 added cardiac cath codes and only eight cardiac cath codes that remain the same.



To start with, here we will focus on the rules that apply jointly to new left (LHC) and right heart cath (RHC) codes 93451-93453:

93451: RHC including measurement(s) of oxygen saturation and cardiac output, when performed

93452: LHC, including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed

93453: Combined RHC and LHC including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed.



Remember: Some of the deleted cardiac cath codes are 93501 (Right heart catheterization), 93510 (LHC …), and 93526 (Combined RHC and retrograde left heart catheterization), which you may have used in reporting similar services last year. The entire list of deleted codes includes 93501, 93508-93529, and 93539-93556.



Taking a look at the overarching section guidelines



As you would anticipate with so many code changes, CPT offers new 'Cardiac Catheterization' section guidelines to help you use the just-in codes the right way.



Families: Keep congenital case codes separate



CPT segregates the cardiac cath codes into two families:



a) For congenital heart disease



b) Those for all other conditions



Codes 93451-93453 fall under the "all other" family, however do not miss that CPT guidelines include them in the codes proper for cases involving 'anomalous coronary arteries, patent foramen ovale, mitral valve prolapse, and bicuspid aortic valve'. What's more, there is no separate code for congenital LHC.



What is included: Cath Introduction to Closure



According to CPT section guidelines, a cardiac cath is a diagnostic medical procedure including all of the following:

Introduction, positioning as well as any required repositioning of catheter(s) within the vascular system

Recording intracardiac and/or intravascular pressure(s)

Final evaluation and report of the procedure



If you verify the codes in the manual, you will also find the symbol indicating the codes include conscious sedation when performed by the same physician.



Codes 93451-93453 also include the 'road mapping' angiography the cardiologist uses to place the catheters. This means you shouldn't code injections separately or the imaging supervision and report related to the road mapping. But then you may report contrast injections and the supervision and report for imaging that has a separate procedure code.



In the end, CPT guidelines declare that you shouldn't separately report placing the closure device at the access site. Also, you should not report any contrast injection required for placing the closure device.



Add-on codes: Capture separate injection



CPT added various new add-on codes that you may report in addition to multiple cardiac cath codes, including 93451-93453.



First are various imaging/injection procedure codes:

RV/RA angiography: +93566

Aortography: +93567 –

Pulmonary angiography: +93568



CPT's 'Injection Procedures' guidelines show that the above codes don t include catheter introduction; but then they do include repositioning the catheter and using automatic power injections. Also, you have CPT's approval to report any combination of +93566, +93567, and +93568 with your cardiac cath code. For instance, if the cardiologist carries out and documents both aortography and pulmonary angiography, you may use both +93567 and +93568. You are not limited to reporting just one code.



To add to it, if the cardiologist carries out angiography of noncoronary vessels "as a distinct service," you should take a look at the Radiology and Vascular Injection Procedures sections to find the proper codes.



More add-on codes: Capture Hemodynamic Response Opportunity



If the cardiologist administers a pharmacologic agent or has the patient exercise to evaluate hemodynamic response, you may use the following apart from the cardiac cath codes:

Agent: +93463:

Exercise: +93464



Use each code only once per cath procedure. CPT guidelines show that the above codes are proper when the cardiologist uses the pharmacologic agent or exercise with the specific reason of repeating hemodynamic measurements to assess hemodynamic response.