Overview
This lecture explains the basics of coding cardiac catheterizations, highlights key considerations when reviewing reports, and provides guidance on selecting the correct procedural codes and add-ons.
Understanding Cardiac Catheterization (Cath)
- Cardiac catheterization is a diagnostic procedure using imaging to evaluate heart function and detect problems.
- Dye is injected via a catheter to visualize the heart and blood vessels.
- Traditionally, coding required separate codes for catheterization, injection, and imaging.
Coding Process & Key Considerations
- In 2011, codes were updated to bundle injections and imaging for non-congenital caths.
- First, determine if the cath is for a congenital (present at birth) condition or not.
- Identify which side of the heart was catheterized: right, left, both, or vessels only.
- Check for any add-on procedures that can be coded in addition.
Common Cardiac Cath CPT Codes
- Right heart cath only: 93451.
- Left heart cath with coronary arteries: 93454; with bypass grafts: 93455.
- Combined right and left heart cath: 93460 (or similar, verify bundle specifics).
- Non-congenital cath codes (e.g., 93456, 93457) include injections and imaging.
- For native vessels: 93454; for native and bypass grafts: 93455.
- Congenital heart cath codes: 93530–93533; injections and imaging are billed separately.
- Add-on codes: right ventriculography (93566), aortic imaging (93567), pulmonary angiography (93568).
Add-On Procedures & Codes
- Transseptal approach (through heart septum): 93462.
- Pharmacologic agent administration: 93463.
- Physiologic exercise study during cath: 93464.
- Intravascular ultrasound in coronary vessels: 92978.
- Transcatheter intracoronary stent placement: 92980.
- Fractional flow reserve (FFR), initial vessel: 93571; additional vessels: 93572.
Case Examples Summary
- Left heart cath with stent and IVUS on LAD: use 93459 (cath), 92980 (stent), 92978 (IVUS).
- Add FFR code 93571 (and 93572 for additional vessels) if performed.
Key Terms & Definitions
- Cardiac catheterization — Diagnostic imaging procedure using a catheter and dye to visualize the heart and vessels.
- Congenital — Condition present at birth.
- CPT codes — Standardized codes for reporting medical procedures.
- Intravascular ultrasound (IVUS) — Imaging from inside the blood vessel using ultrasound.
- Fractional flow reserve (FFR) — Measurement to assess blood flow and vessel blockage.
- Stent — Small tube placed inside a vessel to keep it open.
- Add-on code — Extra code for additional procedures performed during the main procedure.
Action Items / Next Steps
- Review CPT code descriptions for cardiac catheterization and related add-on codes.
- Practice abstracting key details from sample cath reports: congenital vs. non-congenital, side(s) catheterized, add-on procedures.
- Watch suggested patient-oriented YouTube videos on the cardiac cath procedure for visual understanding.