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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