Take a Closer Look at the Guidelines that Apply Jointly to 93451-93453

If you are aware where to look, add-on code opportunities do exist.


Major overhaul sums up 2011 CPT changes to cardiac catheterization coding fairly well. In actual fact, you have deleted cardiac cath codes, 20 added cardiac cath codes and only eight cardiac cath codes that stay the same.


This article focuses on the rules that apply jointly to new left (LHC) and right heart cath (RHC) codes 93451-93453.


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


Look at the overarching section guidelines


As you would expect with so many code changes, 2011 CPT offers new 'cardiac catheterization' section guidelines to help you use the new codes properly.


Here's a closer look at the guidelines that apply jointly to 93451, 93452, and 93453.


Families: Keep Congenital case codes separate


CPT divides the cardiac cath codes into two families:

Those for congenital heart disease

Those for all other conditions


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


What is included: Cath introduction to closure


CPT section guidelines point to the fact that a cardiac cath is a diagnostic medical procedure including all of the following:

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

Recording intracardiac and/or intravascular pressure(s)

Final evaluation & report of the procedure.


In the manual, if you check the codes you will also see the symbol indicating the codes include conscious sedation when carried out by the same physician.

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


In the end, CPT guidelines. state that you shouldn't report placing the closure device at the access site. You also shouldn't report any contrast injection required for placing the closure device.


Add-on codes: Capture Separate Injection


CPT created various new add-on codes that you may report in addition to multiple cardiac cath codes (93451-93453 included).


First are various imaging/injection procedure codes:

RV/RA angiography: +93566

Aortography: +93567

Pulmonary angiography: +93568


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


In addition, if the cardiologist carries out angiography of noncoronary vessels "as a distinct service," you should turn to the Radiology and Vascular Injection Procedures sections to find the proper codes.


More add-on codes a pharmacologic agent or has the patient exercise to evaluate hemodynamic response, you may code the following apart from the cardiac cath codes:


Agent: +93463


Exercise: +93464


You should use each code only once per cath procedure. As per CPT guidelines, the above codes are proper when the cardiologist uses the pharmacologic agent or exercise "with the exact purpose of repeating hemodynamic measurements to assess hemodynamic response. For instance, for a Floran study, you may report +93463.