Vol. 18 Issue 2
Coding for a Cardiac Catheterization
Carefully read the documentation to identify all of the procedures performed, including injection and imaging procedures.
Preoperative and Postoperative ICD-9-CM Diag-noses: Mild coronary artery disease
History: This 73-year-old WF was admitted to this facility with substernal chest discomfort and increasing dyspnea. She notes increasing fatigue as well. She denies any PND, orthopnea or peripheral edema. Risk factors are positive for hypertension and for family history but negative for diabetes or smoking. Medications include Virilon, Coumadin, Estrace, Pepcid, Synthroid and Diazide.
Physical Examination: BP 130/80 in the right arm, sitting. Pulse 80 and regular. Appearance: well-developed, well-nourished WF. Skin: dry. HEENT: PERRLA. Neck: no jugular venous distention. Carotids: equal and regular without bruits. Chest: clear. Cardiovascular system: no heaves, thrills or palpable heart sounds. S1 and S2 are normal. No gallops, murmurs or rubs. Abdomen: soft and nontender without masses or organomegally. Peripheral pulses were good, and there was no edema.
Cath Technique:The right groin was prepped and draped. The area was infiltrated with 1% Xylocaine. The right femoral artery was cannulated with a 17g needle, followed by a J-shaped guide wire and 6F sheath. A Judkins left coronary catheter was advanced into the left coronary, and this was visualized. This was replaced with a Judkins right coronary catheter through which the right coronary was visualized. This was replaced with a pigtail catheter through which a ventriculogram was done. This was removed, the sheath was removed, and pressure was applied to the groin for hemostasis. Ao 110/70. LV 110/9.
Diagnosis:Mild coronary artery disease and normal left ventricular function.
Right Coronary Artery:This is the dominant vessel, which has mild irregularities.
Left Coronary Artery:Left main trunk: normal; left anterior descending: mild irregularities; circumflex: mild irregularities.
Left Ventricle:There is no left ventricle outflow tract obstruction. The aortic and mitral valves appear normal. All segments of the left ventricle contract normally. Patient arrived in the cardiac cath lab. Denies chest pain. Prepulse: +3 rt dp, Pulse Ox: 96 percent.
Procedure(s):Coronary angiography; left heart cath. Rt. groin draped and prepped per protocol. The patient was given Versed 2 mg IV and Xylocaine 2% rt. groin SQ. HR: 77. AO 113/68/87. Left ventricular angiogram performed. HR: 77, LV 125/9/13. Isovue 25 contrast given. HR: 78, AO 108/13/44, LV 104/79/62. Pigtail catheter removed. Patient TPW. Denies chest pain. Isouve 80/100. Sheath to be removed in recovery room. Postpulse: +2 repedal pulse. There were no complications. Patient departed cardiac cath lab.
Pre- and postoperative:
414.01 Coronary atherosclerosis of native coronary artery
In the physician documentation, identify all of the procedure(s) performed. The above case indicates that a left heart catheterization was performed with coronary angiography and ventricular angiography. In addition to the catheterization and injection procedures, imaging services also were provided.
You will first look in the CPT index under the term Catheterization, followed by Cardiac. Scanning the list of choices, you will see several procedures that must be reviewed:
Left Heart 93510-93524
The next procedure to look up in the index is Angiography under which the term Heart Vessels is listed. The only entry under this term is Injection 93545.
After reviewing the above-listed codes, you will determine that the following codes are appropriate for both the professional and facility assignments.
93510 Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous
93543 Injection procedure during cardiac catheterization; for selective left ventricular or left atrial angiography
93545 Injection procedure during cardiac catheterization; for selective coronary angiography (injection of radiopaque material may be by hand)
93555 Imaging supervision, interpretation and report for injection procedure(s) during cardiac catheterization; ventricular and/or atrial angiography
93556 Imaging supervision, interpretation and report for injection procedure(s) during cardiac catheterization; pulmonary angiography, aortography, and/ or selective coronary angiography including venous bypass grafts and arterial conduits (whether native or used in bypass)
Note that for 2008, the American Medical Association revised the following codes listed above: 93510 and 93543.
Peggy Hapner is manager of the HIM consulting division at Medical Learning Inc. (MedLearn), St. Paul, MN.