Overview
This episode of the Codcast Podcast, hosted by Terry Fletcher, focuses on key considerations and practical advice for medical coding of cardiac catheterizations, including common mistakes, documentation requirements, and differences between adult and congenital procedures.
Cardiac Catheterization Coding Basics
- Cardiac catheterization is used to diagnose and treat cardiovascular conditions by inserting a catheter into heart vessels.
- The procedure is now commonly done through the radial (wrist) approach for faster patient recovery.
- Patients typically receive moderate sedation, which can be coded if time and supervision are properly documented.
Documentation and Coding Requirements
- For moderate sedation (code 99152), the report must specify the exact duration and direct physician supervision.
- Physicians must document medication used, time under sedation, and their direct role overseeing sedation.
- Coding must distinguish between adult and congenital heart cath procedures; adult codes start at 93451.
Common Coding Errors and Tips
- The most routine heart cath code is 93458 (left heart cath), requiring evidence of crossing into the left ventricle or left ventricular end-diastolic pressure (LVEDP) measurement.
- Code 93454 (coronary angiography only) should be used when the catheter does not cross into the left ventricle.
- Diagnostic intent must be established; repeat injections for intervention preparation are not separately coded as diagnostic.
Clinical Scenarios and Intent
- If a patient returns with new symptoms and a new diagnostic procedure is performed, diagnostic codes can be used again.
- Intent and reason for each procedure must be clear in the documentation to support coding choices.
- Cardiology coding relies heavily on understanding the purpose and sequence of procedures, similar to EKG and stress testing protocols.
Combined Procedures and Code Selection
- Right and left coronary injections remain under left heart cath coding, while true right/left heart caths involve both heart sides with different codes.
- Add-on codes may apply for additional injections, but coders must check what’s included in each code descriptor.
E/M Level of Service Clarification
- “Minimal or none” in E/M data elements means a clinical consideration was made, not that nothing was evaluated or managed.
- Proper documentation is required to justify this credit; simply reporting “none” without clinical reasoning is insufficient.
Announcements and Additional Resources
- Decision Health’s Advanced Specialty Coding Virtual Summits were promoted for further coder education.
- Terry Fletcher offers on-demand webinars and a paid Q&A service for coding, appeals, and regulatory guidance.
Personal Note
- Terry shares personal commentary on football season and general end-of-summer reminders.
Recommendations / Advice
- Review the full code descriptors and ensure coding matches the specific clinical scenario and documentation.
- Document all procedural details, physician supervision, and intent to support coding and compliance.
Questions / Follow-Ups
- Ensure questions about code selection, documentation, or CMS guidance are directed to reliable sources or through professional Q&A services as needed.