1B-Cardiology Coding In the Cath Lab [gjv]

7 LeY!HeartCatheterizaon!with!or!withoutLeY! Ventriculography!and!Coronary!Angiography!$ CodingGuidelines! • Code93458(26)!(leY!heartcatheterizaon!wit...

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2012  Cardiology  Coding:  In  the  Cath  Lab     AAPC  Na9onal  1B  

Terry  Fletcher  Consul9ng,  Inc.    

Speaker:  Terry  Fletcher  BS,  CPC,  CCC,  CEMS,  CCS-­‐P,  CCS,  CMSCS,  CMC.  

www.terryfletcher.net     800-­‐805-­‐8056    

(Do  not  duplicate  without  expressed  wriHen  consent  of  the  author).    

Cardiac  Catheteriza9on  for  2012  

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Pa
Cardiac  Catheteriza
•  Diagnos
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93451(26)  Right  Heart  Catheteriza
93451(26)  Right  Heart  Catheteriza
Coding  Guidelines  

•  For  heart  catheteriza
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93451  Right  Heart  Catheteriza
93503  Monitoring  via  Swan-­‐Ganz  Catheter   •  A  flow-­‐directed  catheter  (for  example,  a  Swan-­‐Ganz   catheter)  is  frequently  inserted  to  monitor  the   pulmonary  capillary  wedge  pressure  of  pa
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 LeL  Heart  Catheteriza9ons    

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Coronary  and/or  Bypass  GraL  Angiography  (including  SVG   and/or  IMA)  Performed  without  Concomitant  LeY  Heart   Catheteriza
Coding  Guidelines   •   Code  93454  (26)  should  be  used  when  diagnos
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Coronary  and  Bypass  GraY  (including  SVG  and/or   IMA)  Angiography  without  Concomitant  LeY  Heart   Catheteriza
Coding  Guidelines   •  Code  93455(26)  should  be  used  when  diagnos
LeL  Heart  Catheteriza9on  with  or  without  LeY   Ventriculography  and  Coronary  Angiography    

•  93458(26)  Catheter  placement  in  coronary   artery(s)  for  coronary  angiography,  including   intraprocedural  injec
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LeY  Heart  Catheteriza
Coding  Guidelines   •  Code  93458(26)  (leY  heart  catheteriza
LeY  Heart  Catheteriza
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LeY  Heart  Catheteriza
•  93459(26)  Catheter  placement  in  coronary  artery(s)   for  coronary  angiography,  including  intraprocedural   injec
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Right  and  LeY  Heart  Catheteriza
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Right  and  LeY  Heart  Catheteriza
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Right  and  LeY  Heart  Catheteriza
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Right  and  LeY  Heart  Catheteriza
Right  and  LeY  Heart  Catheteriza
•  93461(26)  Catheter  placement  in  coronary  artery(s)   for  coronary  angiography,  including  intraprocedural   injec
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Injec
Coronary  Angiography  when  Performed   with  Congenital  Cardiac  Catheteriza
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Bypass  GraY  Angiography  (Including  SVG,  IMA  and   radial)  with  Congenital  Cardiac  Catheteriza
LeY  ventricular  or  LeY  Atrial  Angiography  Performed   with  Congenital  Cardiac  Catheteriza
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Injec
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Right  Ventricular  or  Right  Atrial  Angiography   Performed  with  Cardiac  Catheteriza
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Supravalvular  Aortography  (aor
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Pulmonary  Angiography  Performed   with  Cardiac  Catheteriza
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The  2012  table  below  illustrates  how  these  codes   should  be  reported  when  a  cardiac  catheteriza
Aortography  at  
CPT  and/or  HCPCS  Codes  

MEDICARE:  93458(26)  +  93567  (aor
LeY  Heart  Catheteriza
•  +  93462  LeY  heart  catheteriza
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ELECTROPHYSIOLOGY   •  If  a  transseptal  approach  is  performed  during  an   electrophysiology  abla7on  study  within  the  leG   atrium  or  leG  ventricle,  assign  93462(26)  in  addi7on   to  the  following:   –  93651  Intracardiac  catheter  abla
PHARMACOLOGIC  AGENT  AND  EXERCISE  STUDY  W/CATH  

•  Add-­‐on  code  +  93463  has  been  established  to   describe  pharmacologic  agent  administra
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Pharmacologic  Agent  Administra
intravenous  infusion  of  nitroprusside,  dobutamine,  milrinone,  or  other  agent)   including  assessing  hemodynamic  measurements  before,  during,  aYer  and  repeat   pharmacologic  agent  administra
Coding  Guidelines   •  Code  93463  describes  the  administra
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Physiologic  Exercise  Study   •  +93464  Physiologic  exercise  study  (eg,  bicycle  or  arm  ergometry)  including   assessing  hemodynamic  measurements  before  and  aYer  (List  separately  in   addi
Coding  Guidelines   •  Code  93464  describes  exercise  during  a  cardiac   catheteriza
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Coding  Alert!!!   •  Devices  deployed  for  hemostasis  following  a   cardiac  catheteriza9on  are  now  included  within   the  cardiac  catheteriza9on  codes.  HCPCS  code   G0269  should  no  longer  be  assigned  to  report   the  deployment  of  a  vascular  seal  (e.g.,   Angioseal,  Star  Closure,  Perclose,  Mynx).   •  The  iliac  or  femoral  angiogram  performed  to  determine  if  the   pa0ent’s  anatomy  will  support  a  vascular  seal  is  not   separately  coded.  Chapter  11  of  the  CMS  CCI  Coding  Manual   states,  “A  physician  should  not  separately  report  an  associated   imaging  code  such  as  CPT®  code  75710  or  HCPCS  code   G0278.”     35

Coronary  Interven9ons  

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Interven
Coronary  Anatomy   •  According  to  the  American  Medical  Associa
CSI Navigator® . Powder Springs, GA: Coding Strategies, Inc., 2011. Print.

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Coronary  Anatomy   •  Many  payors,  including  Medicare,  recognize  only  three  major   coronary  arteries.  The  leY  main  coronary  artery  is  not   recognized  as  a  separate  major  coronary  artery.  The  table   below  shows  the  three  major  coronary  arteries  recognized  by   Medicare.   Arteries     Right  Coronary

Branches   Posterior  Ventricular   Posterior  Descending

LeY  Circumflex

Obtuse  Marginal  1   Obtuse  Marginal  2

LeY  Anterior  Descending

Diagonal  Branch  1   Diagonal  Branch  2

CSI Navigator® . Powder Springs, GA: Coding Strategies, Inc., 2011. Print.

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Coding  Guidelines  for  Coronary   Interven
CSI Navigator® . Powder Springs, GA: Coding Strategies, Inc., 2011. Print.

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Mul
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Mul
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Interven
CSI Navigator® . Powder Springs, GA: Coding Strategies, Inc., 2011. Print.

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Interven
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LeY  Main  Coronary  Artery   •  The  leY  main  coronary  artery  splits  into  the  leY   anterior  descending  and  the  leY  circumflex,  both   of  which  are  recognized  by  Medicare  as  major   coronary  arteries;  however,  the  leY  main  itself  is   not  recognized  as  a  major  coronary  artery.   •  According  to  the  American  College  of  Cardiology,1  

–  The  approach  most  consistent  with  exis
1  American  College  of  Cardiology,  Guide  to  CPT®  2004,  p.  66.   CSI Navigator® . Powder Springs, GA: Coding Strategies, Inc., 2011. Print.

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Anatomic  Variants   •  In  approximately  ⅓  of  the  popula
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Coronary  Artery  Sten
CSI Navigator® . Powder Springs, GA: Coding Strategies, Inc., 2011. Print.

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Codes  for  Coronary  Artery  Sten
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Codes  for  Coronary  Artery  Sten
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Codes  for  Coronary  Artery  Sten
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Codes  for  Coronary  Artery  Sten
Drug-­‐Elu
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Drug-­‐Elu
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Coronary  Atherectomy   •  Atherectomy  is  the  removal  of  atherosclero
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Coronary  Atherectomy   Types  of  Atherectomy   •  Different  types  of  atherectomy  catheters  use  different   methods  for  removing  the  plaque.  Some  examples   include:   –  Direc
Coronary  Atherectomy   Types  of  Atherectomy  (con’t.)   •  Some  examples  include:   –  Rota
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Codes  for  Atherectomy   •  Code  92995  is  reported  for  atherectomy  of  a  single   coronary  artery.  Code  92996  is  an  add-­‐on  code  that  is   reported  for  atherectomy  of  each  addi
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Codes  for  Atherectomy    Coronary  Atherectomy  Examples:   •  EXAMPLE:  Atherectomy  of  leY  circumflex  and  obtuse   marginal  branch.   •  CODES:  92995-­‐LC   •  If  atherectomy  is  performed  in  two  or  more  coronary   arteries,  the  first  artery  is  reported  with  92995  and  the   second  or  addi
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Coronary  Angioplasty  (PTCA)   •  Percutaneous  transluminal  coronary   angioplasty  (PTCA)  is  a  therapeu
Coronary  Angioplasty  (PTCA)   Codes  for  PTCA   •  Code  92982  is  reported  for  PTCA  of  a  single  vessel.  Code   92984  is  an  add-­‐on  code  that  is  reported  for  PTCA  of  each   addi
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Procedure  Report  Example  Cardiac   Cath  &  Interven
Procedure  Report  Example  Cardiac   Cath  &  Interven
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Procedure  Report  Example  Cardiac   Cath  &  Interven
ASSESSMENT:   90%  in-­‐stent  restenosis  of  the  leY  circumflex.   50%  mid  leY  anterior  descending  stenosis.   Mild  leY  ventricular  dysfunc
•  PLAN:  Proceed  with  PTCA  of  the  os
Procedure  Report  Example  Cardiac   Cath  &  Interven
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