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Coding guidelines for interventional cardiology - LHC, RHC and Coronary Angiogram


Left Heart Catheterization

The physician threads a catheter to the heart, most frequently through an introducing sheath placed percutaneously into the femoral, brachial, or axillary artery using retrograde technique. Using this technique, the catheter passes through the aortic valve into the left ventricle. Blood samples, pressure and electrical recordings, and/or other tests are performed. ECG monitoring for the entirety of the procedure is included.

Right Heart Catheterization

The physician performs a right heart catheterization for congenital cardiac anomalies. The physician investigates congenital cardiac anomalies by measuring pressures, taking blood samples for oximetry, and/or injecting contrast to assess chamber size and function. The physician places an introducer sheath in a vein (typically, the femoral vein) using percutaneous puncture. The physician places a lumen catheter through the introducer sheath into the femoral vein and advances it, under fluoroscopic guidance, to the heart chamber receiving venous circulation. The physician may use the fluid filled catheter to record intracardiac pressures, withdraw blood samples, or inject radiopaque contrast material. The physician removes the catheter and sheath from the femoral vein. Pressure is placed on the wound for 20 to 30 minutes to stem bleeding.

Coronary Angiogram

Coronary angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the heart.

Coding guidelines for LHC, RHC and Coronary Angiogram

Catheterization for anomalous coronary arteries, patent foramen ovale, mitral valve prolapse and bicuspid aortic valve should be reported with the non-congenital catheterization codes (93451-93464 and 93566-93568).

Use CPT code 93541 or other appropriate right heart catheterization code (93543, 93456, 93457, 93460 or 93461) when right heart catheterization is done in a cardiac catheterization laboratory or in an interventional radiology laboratory and the procedure is done as part of a formal cardiac catheterization study.

The CPT codes for right heart catheterization are to be reported only when they pertain to diagnostic studies. Therefore, they should not be separately coded when a flow-directed catheter (e.g., Swan-Ganz) is placed in the right heart for monitoring purposes or when an endomyocardial biopsy is performed without obtaining hemodynamic data not previously available.

Use CPT code 93503 (Swan-Ganz) when the procedure is done at bedside (e.g., critical care unit/operating room suite) and the procedure is done for the purposes of hemodynamic monitoring. See also Coding guidelines for Swan-Ganz catheterization.

When an endomyocardial biopsy (CPT code 93505) is performed during cardiac catheterization, bill only one unit of service regardless of the number of biopsies taken.

CPT codes 93454 and 93455 (catheter placement, angiography) should be billed, as appropriate, when coronary or bypass angiography without left heart catheterization is performed. CPT codes 93454 and 93455 may be billed only once per catheterization.

The new CPT codes (2011) for Cardiac Catheterization include all dye injections for angiography, catheter insertion/replacement and repositioning, and the supervision and interpretation. Component services are no longer separately billable. Codes may be billed once per catheterization encounter.

CPT codes 93561-93562 may not be billed with any catheterization codes.

When a catheterization involving multiple components is performed, the single CPT code including all of the components should be billed. Services for the individual component parts may not be billed. CPT codes 93563-93565 may only be billed with CPT codes 93530-93533. Codes for right atrial/ventricular angiography, supravalvular aortography and pulmonary angiography may be billed as add-on codes with any of the catheterization codes.

The transeptal/transapical left heart catheterization (93462) may be billed with 93452-93453, 93458-93461, 93651 and 93652. This code may only be billed when there is a puncture of an intact septum and should not be billed if the catheter is advanced into the left atrium through a patent foramen ovale or atrial septal defect.

Pharmacologic agent administration (93463) and Physiologic exercise study (93464) may only be coded when performed with pre-, intra- and post-intervention hemodynamic and function measures as a diagnostic test or to evaluate potential therapeutic interventions.

Percutaneous insertion of an intra-aortic balloon catheter may be coded separately when performed during the same encounter that cardiac catheterization or coronary angiography is performed.

The CPT codes for repair of blood vessel, direct (35201, 35206 and 35226) and repair of blood vessel with graft other than vein (35261, 35266 and 35286) are codes for open repairs of these vessels, and should not be used to bill for the use of percutaneous vascular closure devices (G0269) with angiographic, cardiac catheterization and interventional cardiology or radiology procedures.

Selective extra-cardiac angiography performed during cardiac catheterization, when medically necessary, should be billed using the appropriate codes from the 36120- 36254 and 75662- 75716 series. These codes should also be billed when these angiographic services are performed unrelated to cardiac catheterization.

The following CPT codes should not be reported with cardiac catheterization unless they are performed for specific conditions that warrant selective investigation 
  •     Aortography codes: 75625-75630 and 75650-75660;
  •     Angiography codes: 75662- 75716;
  •     Introduction of needles or placement of catheters, codes 36120- 36254;
  •     Non-selective renal and iliac angiography (G0275 and G0278).
Non-selective renal or iliac arteriography during the same encounter as the cardiac catheterization may only be reported using G0275 and G0278, respectively. These codes include the supervision and interpretation. Codes from 36120 through 36254 and 75625 through 75716 should only be coded if they are used to code selective studies and were medically necessary for diagnostic purposes. 

Selective extra-cardiac angiography performed during cardiac catheterization, when medically necessary, should be billed using the appropriate codes from the 36120- 36254 and 75662- 75716 series. These codes should also be billed when these angiographic services are performed unrelated to cardiac catheterization.

Modifier Guidelines

Coronary angiography procedures, performed during a therapeutic coronary artery procedure, that are integral parts of the procedure (e.g., guiding arteriograms), are considered to be part of the percutaneous coronary intervention and not separately reportable diagnostic procedures. However, when billing for a diagnostic cardiac catheterization or angiography, which has not been previously performed, but now is performed on the same day as a separate procedure prior to percutaneous coronary intervention, then the 59 modifier should be appended to the codes 93454 – 93461 as appropriate.

Non-covered services should be billed with modifier –GA, -GX, -GY, or –GZ, as appropriate.

See also 'Place of service Codes for Cardiac Catheterization and Coronary Angiography'

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