all right the first one this is the two and a half hour one coding cardiac casts um seemed like an innocent little question so um I need help in Billing cardiac cast I'm new to Cardiology and she gives two patient examples so what I want to do is is teach what cardiac caths are and then go and try answer the the questions [Music] [Applause] [Music] yeah we had to go to making separate sheets to to do the answers for your questions because it's just so much we can't fit them on on the slides so here we go um coding cardiac Cass 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 what is it really what are they doing and it's a diagnostic procedure they're not trying to fix anything they're 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 Dy um going through the vessel so they can visualize that in order to get the Dy in they got to put a catheter up there okay so if you can keep that in mind that will help you I did find um really two excellent YouTube videos that are designed more for patients who are about to get the procedure but very very visual I I will invite you to go ahead and click on them even if you go to YouTube and Just Google cardiac catheterization procedure um I'm not Google uh YouTube and for our replay club members that get the handout packet you know this will be hyperlink and you can go check it out so prior to 2001 when you coded a cardiac cath you actually needed three codes at at a minimum you needed one catheterization code to say if it went on the right or the left you needed one or more injection codes because wherever you inject a die would get a code and then one or more imaging codes you know where did you take images was it up 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 you're looking at a cardiac cath report is was it for a congenital reason or not because that's going to change how you do your coding that's the number one 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 and then the last thing was are there any add-on procedures that were done that you're allowed to code as well so um for my day job I had to update these codes in 2011 and so so I was like as I've said many times on this webinar I'm a very visual learner and I was reading all the changes and I'm like I'm not getting it so I had to make my little chart so I'm going to share that with you here and by the way CPT has their own chart on page 4 93 to 96 if you have the professional version but for me that wasn't working it was on four pages it was unwieldy and it it wasn't how I thought I wanted to start with the way the reports often State out uh start out which side are they doing the cath rization so that's what I look for in the report first is it a right heart cath only a left heart cath only or a combo okay or it could be vessels only sometimes they don't even go into the chambers they just look at the vessels the the major coronary arteries around the heart so for a right heart cath the the default code if you will is 93456 and these these are all in this chart non- congenital codes because the non- congenital codes bundle in the injections and the Imaging now they they didn't used to but now they do so it's just one code to report that now if it was also done of byass graphs because they many times they'll do cardiac cast to make sure the the graphs are still open and the blood's flowing through them nicely still that's 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 arteries you're just going into the right heart chambers that's your 93451 then your left heart cath same pattern um the default with bypass graphs left ventricle only they include the injections and imaging okay combo same thing default with bypass just The ventricle only they all include injections and imaging so by putting it in this visual you're like oh these are aren't so hard after all okay um vessels only if it's the native vessel meaning the vessel you were born with it's not a bypass graft vessel it's 93454 if it's a native vessel and a bypass then it's 93455 and again both of them include injections and imaging um now here's some add-on codes injection add-on codes the um right ventricular or right atrial an angiography is not included a lot of um coders think that it's that it is in the codes that I just went over for the right heart cast it's not this is an add-on code you're allowed to build that if it was done if they do an aort um Imaging of the aorta that's your 93567 if they do of the pulmonary vessels pulmonary angiography it's 93568 so these codes can be added on to one of the primary catheterization codes then other add-on codes are 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 can't do that they have to go through a different way and if it's a transpal route to get there they literally go through the septum of the heart it's 93462 as an add-on code so it increases the the rvu the value of what the physician's going to bill out if pharmacologic agent Administration was done you can build the add-on code 93463 and if a physiologic exercise study was study was done at the same time as a cardiac cath then it's 93464 so hopefully this chart um will help you and um for the replay club members you'll you'll get access to that as well so that was for non-congenital if you're talking about congenital condition that a cardiac cath is being done for then you're going to use this code range here 93530 to 935 33 I was going to show you my document camera but it's acting up um now this the congenital ones do not include the injection so you you can bill for them separately that's what got me really confused when I looked at these changes was they were saying that oh now injections and imaging bundled in but then I saw these injection codes I'm like wait a minute but when you really read them carefully you'll see they all say congenital either in the code description or in the parenthetical uh note so that's the difference and that's why that's the number one thing you need to ascertain is it A congenital problem or not now this is starting to get into the person's question if diagnostic angiography is performed during the same time as therapeutic so so we've got diagnos diagnostic trying to figure out what's wrong therapeutic trying to fix something you can append 59 to the supervision and interpretation codes and you're you're allowed to build them in addition to now for supervision and interpretation we did that last webinar so and I believe yes boy just um put up the video clip for that so it's on the codingcertification.org website so you can check that out if you weren't in attendance last month and that will kind of go into that stuff um Sni codes are not used to report post intervention injections in the coronary vessels to determine level of effective Effectiveness those are bundled in you know you do a procedure and then you do something to double check to make everything sure everything's okay before you close up so to speak that's bundled in and you can get more information on that in the CPT changes 2011 insiders 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 um also cardiovascular stance and other therapeutic interventions um I was asking Alicia I said didn't I cover that so I went and actually Googled my own site and sure enough we have two videos um where I had covered that so um I put the hyperlinks in here for um you know when you get the the uh transcript but if you just go to codingcertification.org and type in stance in our search box you'll find these two um video clips to to look up The Stance and basically it's things that are done to the vessels to treat them so the cardiac cath is to figure out something that's wrong a stent will Bridge open the vessel if it's if it's got a weakened wall and then we've got uh like plaque removal codes uh that kind of thing so the reason I mention all that is because the questioner said it was a cardiac cath question but there was also questions about these procedures highly highly abbreviated so um she said the doctor did a 9 3459 with the stent and ivus on the on the lad and descending aortogram and the second patient did the same thing with a stent ivu IV us ffr and an L so first of all we need to Define what all this alphabet soup is the first thing I defined is the code and basically 9 3459 is the left heart cath if we go take a peek at that again right here this is the one with bypass graphs okay so now that one code is telling the story The catheterization on the left side it's with bypass codes and we don't build injections or Imaging separately because it's bundled so that takes care of the first thing and of course you gave me the codes that wasn't hard for me to figure out um then she said stent and ivus L is actually referring to the vessel so there's a left anterior descending coronary artery and you need to figure that out because there's some procedures that are done on noncoronary vessels and then those that are done on coronary so you need to make that distinction so the lad is a coronary artery then an ivus was done that's intravascular ultrasound which basically is allowing you to look at a vessel from the inside out it's kind of cool and there is a great site angioplasty.org if you want to um go read about that it's it's very very good reading and so the code for that is 929 78 this is the coronary one now there's one in the 30,000 series but that's for noncoronary IV us okay so that would be the code for that so so far we have the 9 3459 and the 9 2978 now for the stent again there's stents in non-coronary vessels and then there's stent in um coronary vessels so this one is 9 to 980 trans catheter placement of intercoronary stent or stance okay and then for the descending aortogram because we're dealing you know with the the heart and the descending aortogram typically now I don't have an op report to go by but typically that might be done just to evaluate the site of where they put the catheter to make sure everything was okay um so I don't think there's a separate code for that um so I didn't 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 9357 one for the initial vessel and if you do more than than one in that same session then there's an add-on code 572 okay so that's kind of how you break it down I hope that helps understand the cardiac caths better I might add to only because someone asked me the other day you know what does congenital mean and it's real simple it just means you were born with it right yep get more CPC exam tips coding certification training and ceu credits go to www.co codingcertification.org [Music]