Overview
This lecture covers coding for congenital heart catheterizations, focusing on recent CPT code updates, key documentation points, and procedural distinctions for accurate medical coding.
Importance of Staying Up-to-Date
- CPT codes for congenital heart catheterizations changed significantly on 12/31/2021 (now 93593–93597).
- Always verify code information with up-to-date resources, as reputable sources may be outdated.
- Track annual coding changes and make personal notes for quick reference.
Cardiac Catheterization Coding Basics
- Cardiac catheterization CPT codes 93454 and 93455 are used for procedures without congenital anomalies.
- These codes include dye injections, angiograms, catheter placement, repositioning, and interpretation.
- Congenital heart catheterizations use CPT codes 93593–93597.
Coding Congenital vs. Non-Congenital
- There are distinct code categories for congenital heart disease versus acquired heart conditions.
- Codes 93593–93597 are used only when a congenital defect is identified.
Abstracting Documentation for Accurate Coding
- Key details to extract: congenital vs. non-congenital, normal native connection vs. abnormal native connection.
- Identify if the procedure was right heart, left heart, or both.
- Use bubble and highlight techniques in CPT manuals to speed up and improve code selection.
Procedure Overview
- Procedure often starts with guide wire insertion through femoral vein, moving up to heart chambers.
- Catheter advances to right atrium, ventricle, and pulmonary arteries for pressure and oxygen measurements.
- Angiograms are performed and reported separately.
Normal vs. Abnormal Connections
- Code 93593 for procedures with normal native cardiac connections.
- Code 93594 for abnormal native cardiac connections in congenital defects.
- Placement in a morphological left ventricle/atrium can still be coded as right heart cath if entry route was on the right.
Cardiac Output Measurements (93598)
- 93598 is used for cardiac output measurement studies, billed separately but in conjunction with 93593–93597.
- Methods include indicator dye or thermal dilution via Swan-Ganz catheter.
Key Terms & Definitions
- Congenital Heart Defect — A heart abnormality present from birth.
- Cardiac Catheterization — Insertion of a catheter into the heart to diagnose/treat conditions.
- Normal Native Connection — Standard anatomical heart vessel connections.
- Abnormal Native Connection — Anomalous vessel connections due to congenital defects.
- Swan-Ganz Catheter — Special catheter for measuring cardiac output via thermal or dye dilution.
Action Items / Next Steps
- Review and annotate CPT codes 93593–93597 in your manual.
- Research the reasons for right, left, or combined heart catheterizations.
- Practice abstracting procedure details from sample reports.
- Brush up on heart and vascular anatomy, especially relating to access sites and great vessels.
- Submit further topic requests as needed for additional guidance.