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Coding for Interventional Cardiology Procedures an Overview of the Complex Coding for Various Cardiology Procedures

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Coding for Interventional Cardiology Procedures an Overview of the Complex Coding for Various Cardiology Procedures CODING & REIMBURSEMENT Coding for Interventional Cardiology Procedures An overview of the complex coding for various cardiology procedures. BY ROSEANNE R. WHOLEY hen coding and billing for coronary inter- ventions, it is important to know that “When coding and billing for coronary Medicare only recognizes three major coronary arteries. These are the left ante- interventions, it is important to know Wrior descending artery, the right coronary artery, and that Medicare only recognizes three the circumflex artery. Branch vessels are considered an major coronary arteries.” integral part of these three major arteries. Interventions in these vessels are reported with the appropriate coro- nary artery modifiers: LAD (left anterior descending), On January 1, 1995, the regulation was changed to the RCA (right coronary artery), and LC (left circumflex). current method. Only the most highly valued proce- dure would be reported with the initial vessel code in COMPLETE PROCEDURAL TERMINOLOGY the first vessel. Any other therapeutic coronary artery The Complete Procedural Terminology (CPT) codes procedures in different vessels are reported using the for interventions in each of these vessels include an ini- “each additional vessel” code for the same procedure, tial vessel code and each additional vessel code. This is which is reimbursed significantly less than the initial true for: vessel code. • 92982 Percutaneous transluminal coronary angio- If a single intervention is utilized in more than one of plasty (PTCA), single vessel these three vessels, the first vessel is to be identified • 92984 PTCA, each additional vessel using the respective “single vessel” code. Each additional and major coronary artery treated is identified by using the • 92995 Percutaneous transluminal coronary atherec- “each additional vessel” code. Interventions in the tomy, with or without balloon angioplasty, initial branch vessels are considered a part of the intervention vessel in the major vessel and are not reported separately. • 92996 Percutaneous transluminal coronary atherec- Anatomic variants should be reported as closely as pos- tomy, each additional vessel sible to a corresponding major vessel and not separately and coded. • 92980 Transcatheter placement of an intracoronary stent(s) percutaneous, with or without other thera- MEDICARE CORRECT CODING INITIATIVE peutic intervention, initial vessel The Medicare Correct Coding Initiative (CCI) defines • 92981 Transcatheter placement of an intracoronary a hierarchical schema in technical complexity that exists stent(s) percutaneous, each additional vessel. when multiple coronary interventions are performed in a single session. This means that certain services super- Before 1995, multiple-vessel procedures were per- sede other services and the other services are not formed with the initial vessel codes and a -51 multiple reported separately. Generally, stent placement super- surgical modifier added to the lower-valued procedure. sedes atherectomy, which supersedes angioplasty. When 20 ICARDIAC INTERVENTIONS TODAYIJUNE 2007 CODING & REIMBURSEMENT multiple interventions are combined during a single ses- the therapeutic procedure, and the S&I, are included in sion on multiple vessels, the most complex intervention the therapeutic procedure code. is to be reported by using that intervention’s “single ves- However, if a diagnostic catheterization is performed sel” code and additional interventions using the appro- before any therapeutic intervention, it is coded sepa- priate “each additional vessel” code. Only one interven- rately, along with the intervention. When a diagnostic tional procedure code per session is applied to each of cardiac catheterization is performed and immediately the three major coronary arteries. Therefore, stent followed by a therapeutic procedure, such as PTCA, all placement, angioplasty, and/or atherectomy may not be of the appropriate cardiac catheterization codes should paid on the same vessel. Additional major-vessel inter- be reported in addition to the code for the therapeutic ventions may be reported using the “each additional procedure. vessel” codes, including the appropriate coronary artery The cardiac catheterization codes are split into three modifier. main categories: cardiac catheterization procedure codes, injection codes, and imaging S&I codes. “Anatomic variants should be DIAGNOSTIC CARDIAC reported as closely as possible to a CATHETERIZATION CODES corresponding major vessel and not The diagnostic cardiac catheterization codes (the separately coded.” physician professional component is reported with a -26 modifier) are: • 93501 Right heart catheterization For example, if PTCA is performed in the LAD artery • 93508 Catheter placement in coronary artery(s) and the vessel is subsequently stented, the PTCA is bun- arterial coronary conduit(s), and/or venous coro- dled into the stent placement code, which is the highest nary bypass graft(s) for coronary angiography with- paying service. This means that when a stent is placed out concomitant left heart catheterization because of an abrupt closure of a vessel during PTCA, • 93510 Left heart catheterization, retrograde, from or as a scheduled event, the PTCA in that same vessel is the brachial artery, axillary artery, or femoral artery: not reported separately. The only CPT code that would percutaneous be used to report this service is 92980-LD. • 93511 Left heart catheterization, retrograde, from Note that there are three modifiers used to identify the brachial artery, axillary artery, or femoral artery: the three major coronary arteries: by cutdown • -LD Left anterior descending • 93514 Left heart catheterization by left ventricular • -RD Right coronary artery puncture • -LC Left circumflex. • 93524 Combined transseptal and retrograde left If PTCA is performed in the LAD artery and also in heart catheterization the RCA, and a stent is placed in the circumflex, the • 93526 Combined right heart catheterization and coding of the procedure would be: retrograde left heart catheterization • 92980-LC Stent, initial LC • 93527 Combined right heart catheterization and • 92982-LD PTCA LAD transseptal left heart catheterization through intact • 92984-RC PTCA, each additional vessel, RCA. septum (with or without retrograde left heart Note that if multiple stents were placed side by side catheterization) in a single vessel, the stent code would be reported only • 93528 Combined right heart catheterization with once. left ventricular puncture (with or without retro- Codes 92973 (percutaneous transluminal coronary grade left heart catheterization thrombectomy), 92974 (coronary brachytherapy), • 93529 Combined right heart catheterization and 92978, and 92979 (intravascular ultrasound) are add-on left heart catheterization through existing septal codes for reporting procedures performed in addition opening (with or without retrograde left heart to coronary stenting, atherectomy, and angioplasty, and catheterization are not included in the therapeutic interventions. • 93530 Right heart catheterization, for congenital It is not appropriate to report imaging supervision cardiac anomalies and interpretation (S&I) services for therapeutic coro- • 93531 Combined right heart catheterization and nary artery procedures. The placement of all catheters, retrograde left heart catheterization, for congenital as well as angiography performed during the course of cardiac anomalies JUNE 2007 I CARDIAC INTERVENTIONS TODAY I 21 CODING & REIMBURSEMENT • 93532 Combined right heart catheterization and • 93545 Injection for selective coronary angiography transseptal left heart catheterization through intact • 93555-26 S&I for left ventriculography septum with or without retrograde left heart • 93556-26 S&I for coronary angiography. catheterization, for congenital cardiac anomalies Note that if a -26 modifier is used to describe only the • 93533 Combined right heart catheterization and professional component when the physician component transseptal left heart catheterization through exist- is reported separate from the technical component. ing septal opening, with or without retrograde left heart catheterization, for congenital cardiac anom- CONCLUSION alies. The heart catheterization procedure must be correct- ly defined (left heart, right heart, right and left heart INJECTION CODES catheterization). It is important to remember that, if The possible injection codes for procedures per- during a cardiac catheterization procedure, an injection formed during cardiac catheterization are: is also performed, the correct injection(s) code should • 93539 Injection procedure during cardiac catheteri- be submitted along with the accompanying S&I code. zation for selective opacification of arterial con- No matter how many injection procedures are per- duits, whether native or used for bypass formed, the S&I codes can only be listed one time each. • 93540 Injection procedure during cardiac catheteri- Each type of injection performed may be reported sep- zation for selective opacification of aortocoronary arately. venous bypass grafts, one or more coronary arteries If a history and physical or consultation is performed • 93541 Injection procedure during cardiac catheteri- on the same day of a procedure, the service is billable as zation for pulmonary angiography long as the performing physician is providing an initial • 93542 Injection procedure during cardiac catheteri- evaluation or consult in which the decision to operate is zation for selective right ventricular or right atrial
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