Alright, the first one, this is the 2 Ω hour one: coding cardiac caths.
It seemed like an innocent little question.
So I need help in billing cardiac caths.
Iím new to cardiology and she gives two patient examples.
So what I want to do is teach what cardiac caths are and then go and try to answer the
questions.
So let me click on my little answer sheet and hopefully, that would pull up correctly.
Yeah, we had to go to making separate sheets to do the answers for your questions because
itís just so much, we canít fit them on the slides.
So here we go, coding cardiac caths.
First of all, when I teach this to my students, I make them stop a minute.
We hear it all the time but sometimes, as a coder, we need to stop and ask, ìWhat is
it really?
What are they doing?î And itís a diagnostic procedure.
Theyíre not trying to fix anything.
Theyíre trying to diagnose a problem.
And the way they do that is with imaging.
They want to take a picture of the heart and in order to get a good image, they need to
get dye going through the vessels so they can visualize that.
In order to get the dye in, they got to put a catheter up there.
So if you can keep that in mind, that will help you.
I did find really, two excellent YouTube videos that are designed more for patients who are
about to get the procedure but very, very visual.
I will invite you to go ahead and click on them.
Even if you go to YouTube and just Google cardiac catheterization procedureÖ not Google,
YouTube.
And for our Replay Club members that get that handout packet you know, this will be hyperlinked
and you can go check it out.
So prior to 2001, when you coded a cardiac cath, you actually needed 3 codes at a minimum.
You needed 1 catheterization code to say if itís the one on the right or the left.
You needed one or more injection codes, because wherever you inject the dye would get a code,
and then one or more imaging codes, you know, where did you take images?
Was it of the chambers of the heart?
Was it of coronary vessels?
So in 2011, they came out with packaging these cardiac cath codes.
So what you need to actually go in and abstract for when youíre looking at a cardiac cath
report is was it for congenital reason or not?
Because thatís going to change how you do your coding.
Thatís the number 1 thing you need to figure out.
Then you need to figure out which side of the heart was catheterized.
Was it the right, the left, or both?
Then the last thing is are there any add-on procedures that were done, that youíre allowed
to code as well?
So for my day job, I had to update these codes in 2011.
And so I was likeÖ as I said many times in this webinar, Iím a very visual learner and
I was reading all the changes and Iím like, ìIím not getting it.î So I had to make
my little chart so Iím going to share that with you here.
And by the way, CPT has their own chart on page 493 to 496 if you have the professional
version.
But for me, that wasnít working.
It was on 4 pages, it was unwieldy and it wasnít how I thought I wanted to start with,
the way the reports often start out, ìwhich side are they doing the catetherization?î
So thatís what I look for in the report first.
Is it a right heart cath only?
A left heart cath only or combo?
OkayÖ or it could be vessels only.
Sometimes, they donít even go into the chambers.
They just look at the vessels, the major coronary arteries around the heart.
So for a right heart cath, the default code, if you will, is 93456.
And these are all in this chart, non-congenital codes because the non-congenital codes bundle
in the injections and the imaging now.
They didnít use to but now they do.
So itís just one code to report that.
Now if it was also done of bypass grafts because many times, theyíll do cardiac caths to make
sure the grafts are still open and the bloodís flowing through them nicely still, thatís
going to be code 93457.
And that again, includes injections and imaging.
Then we have the right only and this one does not include any coronary artery so just going
into the right heart chambers.
Thatís your 93451.
Then your left heart cath, same pattern.
The default with bypass grafts, left ventricle only, they include the injections and imaging.
Combo, same thing.
Default with bypass, just the ventricle only.
They all include injections and imaging.
So by putting it in this visual, youíre like, ìOh, these arenít so hard after all.î
Okay, vessels only, if itís the native vessel, meaning the vessel you were born withÖ itís
not a bypass graft vessel, itís 93454.
If itís a native vessel and a bypass then itís 93455.
And again, both of them include injections and imaging.
Now hereís some add on codes, injection add on codes.
The right ventricular or right atrial angiography is not included.
A lot of coders think that it is and the codes that I just went over for the right heart
cath.
Itís not.
This is an add on code.
Youíre allowed to bill that if it was done.
If they do an aorticÖ imaging of the aorta, thatís your 93567.
If they do of the pulmonary vessels, pulmonary angiography, itís 93568.
So these codes can be added on to one of the primary catheterization codes.
Then other add on codes areÖ normally, when they do a cardiac cath, they will start the
catheter in that nice, big, juicy leg vein and thread it on up.
And that YouTube video shows that very well.
But sometimes, they canít do that.
They have to go through a different way.
And if itís a transseptal route to get there, they literally go through the septum of the
heart, itís 93462 as an add on code.
So it increases in the RVU, the value of what the physicianís going to bill out.
If pharmacologic agent administration was done, you can bill the add on code 93463.
And if a physiologic exercise study was done at the same time as a cardia cath then itís
93464.
So hopefully, this chart will help you and for the Replay Club members, youíll get access
to that as well.
So that was for non-congenital.
If youíre talking about congenital condition that a cardiac cath is being done for then
youíre going to use this code range here, 93530 to 93533.
I was going to show you my document camera but itís acting up.
Now this, the congenital ones, do not include the injections so you can bill for them separately.
Thatís what got me really confused when I looked at these changes was they were saying
that, ìOh, now injections and imaging is bundled in.î But then I saw these injection
codes.
Iím like, ìWait a minute.î But when you really read them carefully, youíll see they
all say congenital, either in the code description or in the parenthetical note.
So thatís the difference and thatís why thatís the number 1 thing you need to ascertain.
Is it a congenital problem or not?
Now this is starting to get into the personís question.
If diagnostic angiography is performed during the same time as therapeuticÖ so weíve got
diagnostic - trying to figure out whatís wrong, therapeutic ñ trying to fix somethingÖ
you can append 59 to the supervision and interpretation codes.
And youíre allowed to bill them in addition to.
Now for supervision and interpretation, we did that last webinar soÖ and I believeÖ
yes, Boyd just put up the video clip for that so itís on the codingcertification.org website
so you can check that out if you were in attendance last month and that will kind of go into that
stuff.
S&I codes are not used to report post intervention injections in the coronary vessels to determine
level of effectiveness.
Those are bundled in.
You do a procedure and then you do something to double check to make sure everythingís
okay before you close up, so to speak.
Thatís bundled in.
And you can get more information on that in the CPT Changes 2011 Insiderís View book.
If you belong to any encoders online and you pay extra for the CPT Assistant-type access,
you might have access to this as well.
Also, cardiovascular stents and other therapeutic interventions, I was asking Alicia, ìDidnít
I cover that?î So I went and actually Google-d my own site and sure enough, we have two videos
where I have covered that.
So I put the hyperlinks in here for you know, when you get the transcript.
But if you just go to codingcertification.org and type in stents in our search box, youíll
find these two video clips to look up the stents.
And basically, itís things that are done to the vessels to treat them.
So the cardiac cath is to figure out something thatís wrong.
A stent will bridge open the vessel if itís got a weakened wall.
And then weíve got plaque removal codes, that kind of thing.
So the reason I mentioned all that is because the questioner said it was a cardia cath question
but there is also questions about these procedures, highly, highly abbreviated.
So she said, ìThe doctor did a 93459 with a stent, an IVUS on the LAD and descending
aortagram.
On the second patient, did the same thing, with a stent IVUS, FFR, and an LAD.î So first
of all, we need to define what all this alphabet soup is.
The first thing is defined is the code and basically, 93459 is the left heart cath.
If we go take a peek at that again right here, this is the one with bypass grafts.
Okay so now, that one code is telling the story, the catheterizationís on the left
side.
Itís with bypass codes and we donít bill injections or imaging separately because itís
bundled.
So that takes care of the first thing and of course, you gave me the codes.
That wasnít hard for me to figure out.
Then she said stent and IVUS.
LAD is actually referring to the vessel.
So thereís a left anterior descending coronary artery and you need to figure that out because
there are some procedures that are done on non-coronary vessels and then those that are
done on coronary.
So you need to make that distinction.
So the LAD is a coronary artery then and IVUS was done.
Thatís intravascular ultrasound which basically is allowing you to look at a vessel from the
inside out.
Itís kind of cool.
And there is a great site, angioplasty.org, if you want to go read about that.
Itís very, very good reading.
And so the code for that is 92978.
This is the coronary one.
Now thereís one in the 30,000 series but thatís for non-coronary IVUS.
Okay so that would be the code that.
So far, we have the 93459 and the 92978.
Now for the stent, again, there are stents in non-coronary vessels and then there are
stents in coronary vessels.
So this one is 92980, transcatheter placement of intercoronary stent or stents.
Okay and then for the descending aortagram.. because weíre dealing you know, with the
heart and the descending aortagram, typicallyÖ and I donít have an op report to go byÖ
but typically, that might be done just to evaluate the site of where they put the catheter
to make sure everything was okay.
So I donít think thereís a separate code for that so I didnít put a code for that.
And then FFR, that was in the second abbreviated situation here and that stands for Fractional
Flow Reserve.
And that code is 93571 for the initial vessel.
And if you do more than one in that same session then thereís an add on code, 572.
Okay so thatís kind of how you break it down.
I hope that helps understand the cardiac caths better.
Alicia: I might add too, only because someone asked me the other day you know, what does
congenital mean?
And itís real simple, it just means you were born with it.