Cardiac catheterization is a diagnostic procedure performed by cardiologists or a team of cardiology fellows, nurses and technicians to see how well blood vessels supply the patient’s heart. The procedure involves guiding a thin, flexible tube (catheter) through a blood vessel to the heart to diagnose or treat certain heart conditions, such as clogged arteries or irregular heartbeats.
When it comes to claim submission, the CPT code(s) for the cardiac catheterization procedure(s), should be linked to the appropriate ICD-10-CM diagnosis code(s) that describes the indication for the procedure on the claim. An experienced medical billing company can support cardiology practices with proper claim submission by assigning relevant codes that support the diagnosis done. An AAPC blog provides a clear picture of the current CPT codes related to the procedure.
This procedure is commonly done to evaluate and manage conditions such as – Coronary artery disease, Heart failure, Left ventricular dysfunction, Cardiac arrhythmia, Valvular heart disease, Pericardial and myocardial diseases, Congenital heart disease, and Hemodynamic abnormalities in the right and left sides of the heart. During cardiac cath, doctors can – take X-rays to look for narrowed or blocked coronary arteries (coronary angiography or coronary arteriography), perform a percutaneous coronary intervention (PCI) such as coronary angioplasty, check the pressure in the four chambers of the heart, take blood samples to measure the oxygen content in the four chambers of your heart. Providers can also perform stent placement and Transcatheter Aortic Valve Replacement (TAVR).
Two code families for cardiac catheterization are – one for congenital heart disease and one for all other conditions.
Left heart catheterization (non-congenital)
Left heart catheterization involves evaluation and treatment of coronary artery disease (CAD), assessment of coronary artery bypass graft(s), evaluation and treatment of cardiac arrhythmias, assessment of severity of valvular disorders (aortic stenosis, aortic insufficiency, mitral stenosis, mitral insufficiency) and myocardial disorders (cardiomyopathies), and treatment of valvular heart disease (valvuloplasty, percutaneous transcatheter valve replacement).
CPT® codes to use, when only the left side of the heart is being examined are –
- 93452 Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed
- 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
- 93459 … catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography
Coding Tips
- Report 93452 when coronary angiography is not performed during the left heart cath
- Use 93458 code, when coronary angiography is performed during left heart catheterization
- Look to code 93459 when coronary and bypass graft angiography are performed
- Use modifier 26 to these codes when billing for just the professional component performed by the physician
Right heart catheterization (non-congenital)
Right heart catheterization helps evaluate diverse cardiovascular conditions such as – valvular heart disease, congestive heart failure, cor pulmonale, pulmonary hypertension, intracardiac shunts and extracardiac vascular shunts, suspected cardiomyopathy, myocarditis, suspected rejection of a transplanted heart, and congenital heart disease.
CPT® codes to use when only the right side of the heart is being examined are –
- 93451 Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed
- 93456 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization
- 93457 — with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization
Diagnostic Left and Right Heart Cath
Combined left and right heart catheterization (non-congenital) is performed to evaluate the cardiac function of both the right and left sides of the heart.
CPT® codes to use, when both the right and left sides of the heart are being examined are –
- 93453 Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed
- 93460 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed
- 93461 … catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography
Tips
- For coronary angiography, the medical record should include documentation of the patency of the coronary arteries.
- Modifier 26 can be added to these codes, when appropriate.
Coding Injections and Procedures
Injections
- 93566 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective right ventricular or right atrial angiography (List separately in addition to code for primary procedure)
- 93567 for supravalvular aortography (List separately in addition to code for primary procedure)
- +93568 for pulmonary angiography (List separately in addition to code for primary procedure)
Tips
- Along with the appropriate catheterization code, report an injection procedure for right atrial, right ventricular, aortic, or pulmonary angiography.
- Make sure to document the diagnostic codes to support medical necessity. As with the prior codes, append modifier 26 when appropriate.
There are further more codes related to cardiac cath procedures, highlighted in the AAPC article, which we will discuss in our upcoming blog.
More from This Author
