How To Use CPT Code 93458

CPT 93458 is a code used for 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. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 93458 procedures.

1. What is CPT 93458?

CPT 93458 is a medical code used to describe a specific procedure involving catheter placement in coronary artery(s) for coronary angiography, along with imaging supervision and interpretation. This code also includes left heart catheterization and intraprocedural injection(s) for left ventriculography when performed. Medical professionals use this code to bill for the services provided during this procedure.

2. 93458 CPT code description

The official description of CPT code 93458 is: 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.

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider introduces a catheter through the skin and moves the guide wire into the peripheral artery under fluoroscopic guidance.
3. The tip of the catheter is advanced to the coronary artery opening and secured at the beginning of the coronary artery.
4. The provider injects contrast material through the catheter into the artery to check the position of the catheter and produces angiographic images.
5. An additional catheter is introduced into the left side of the heart under fluoroscopic guidance to measure the pressure and blood flow in it.
6. For left ventriculography, the provider injects contrast through the previously placed catheter into the left ventricle to check the cardiac function under fluoroscopic guidance.
7. The provider removes the catheter and applies pressure for several minutes on the wound to stop the bleeding.
8. The provider who performs imaging supervision and interpretation for this procedure reports CPT 93458.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 93458 services are those who require coronary angiography to assess coronary artery disease or any stenosis within the artery. Additionally, the procedure may be performed on patients who need left heart catheterization and left ventriculography to evaluate cardiac function and blood flow in the left side of the heart.

5. When to use CPT code 93458

It is appropriate to bill the 93458 CPT code when the provider performs imaging supervision and interpretation for a coronary angiography with left heart catheterization and intraprocedural injections for left ventriculography. This code should be used to represent only imaging supervision and interpretation for this procedure.

6. Documentation requirements

To support a claim for CPT 93458, the following information needs to be documented:

• Indication for the procedure, such as suspected coronary artery disease or stenosis within the artery.
• Details of the patient’s medical history and physical examination.
• Details of the procedure, including catheter placement, contrast injections, and imaging supervision and interpretation.
• Findings from the coronary angiography, left heart catheterization, and left ventriculography.
• Any complications encountered during the procedure and their management.
• Post-procedure care instructions and follow-up plan.

7. Billing guidelines

When billing for CPT code 93458, keep in mind the following guidelines and rules:

• Append professional component modifier 26 to the code when reporting only the professional component for the service.
• Append technical component modifier TC to the code when reporting only the technical component for the service, unless the hospital provided the technical component. In that case, do not append modifier TC because the hospital’s portion is inherently technical.
• Do not append a professional or technical modifier to the code when reporting a global service in which one provider renders both the professional and technical components.
• Do not report CPT 93458 in conjunction with certain other codes, as specified in the CPT guidelines.

8. Historical information

CPT 93458 was added to the Current Procedural Terminology system on January 1, 2011. There have been no updates to the code since its addition.

9. Similar codes to CPT 93458

Five similar codes to CPT 93458 and how they differentiate from CPT 93458 are:

1. CPT 93454: This code is used for coronary angiography without left heart catheterization or ventriculography.
2. CPT 93455: This code includes coronary angiography with right heart catheterization, but not left heart catheterization or ventriculography.
3. CPT 93456: This code is for coronary angiography with both right and left heart catheterization, but not ventriculography.
4. CPT 93457: This code includes coronary angiography with right heart catheterization and left ventriculography, but not left heart catheterization.
5. CPT 93459: This code is for coronary angiography with both right and left heart catheterization and left ventriculography.

10. Examples

Here are 10 detailed examples of CPT code 93458 procedures:

1. A 55-year-old patient with a history of chest pain undergoes coronary angiography with left heart catheterization and left ventriculography to assess for coronary artery disease.
2. A 65-year-old patient with a history of hypertension and diabetes undergoes CPT 93458 procedure to evaluate the extent of coronary artery stenosis.
3. A 70-year-old patient with a history of myocardial infarction undergoes CPT 93458 procedure to assess the patency of previously placed coronary stents.
4. A 60-year-old patient with a history of angina undergoes CPT 93458 procedure to determine the need for coronary artery bypass surgery.
5. A 50-year-old patient with a family history of coronary artery disease undergoes CPT 93458 procedure as part of a preoperative evaluation for non-cardiac surgery.
6. A 45-year-old patient with a history of shortness of breath and chest pain undergoes CPT 93458 procedure to assess for coronary artery disease and left ventricular function.
7. A 75-year-old patient with a history of congestive heart failure undergoes CPT 93458 procedure to evaluate the severity of coronary artery disease and left ventricular function.
8. A 62-year-old patient with a history of syncope undergoes CPT 93458 procedure to assess for coronary artery disease and left ventricular function as part of a comprehensive evaluation.
9. A 58-year-old patient with a history of peripheral artery disease undergoes CPT 93458 procedure to assess for concomitant coronary artery disease and left ventricular function.
10. A 67-year-old patient with a history of atrial fibrillation undergoes CPT 93458 procedure to evaluate the extent of coronary artery disease and left ventricular function prior to cardioversion.