Coding Cardiac Catheterizations

First of all what is it? It is a diagnostic procedure. Here are a few
great YouTube videos
1 http://youtu.be/kY5gKdFWT3k
2 http://youtu.be/sXrO52vqUQI
Prior to 2011 you needed three pieces to code a cardiac cath
1 catheterization code
2 injection (of dye) code - 1 or more
3 imaging code - 1 or more
Now we have things packaged up differently.
What you need to abstract:
1 congenital or not
2 which side of heart - right, left or both
3 any add on procedures
Being the visual learner I am I had to put this in a chart. Your
2013 CPT Manual includes a chart as well starting on page 516.
However I like looking at it based on which side of the heart is
being catheterized and narrowing it down from there.
For non-congenital things are bundled so one code represents the
catheterization, the injection and the imaging.

By Laureen Jandroep, CPC, CPC-I, CMSCS, CHCI ~ Instructor (888) 226-5799
www.CodingCertification.org HelpDesk@CodingCertification.org

Location

Code

Includes

Right Heart Catheterization
Default 93456

injections + imaging

With Bypass Grafts 93457

injections + imaging

Right Only - no coronary arteries 93451
Left Heart Catheterization
Default 93458

injections + imaging

With Bypass Grafts 93459

injections + imaging

Left Ventricle Only 93452

injections + imaging

Left & Right Catheterizations
Default 93460

injections + imaging

With Bypass Grafts 93461

injections + imaging

Left Ventricle Only 93453

injections + imaging

Native Only 93454

injections + imaging

Native + Bypass 93455

injections + imaging

Vessels Only

Injection Add On Codes
for selective right ventricular or right atrial 93566
angiography

*only report one of these injection
add on codes per case

for supravalvular aortography 93567
for pulmonary angiography 93568
Other Add On Codes
via a transseptal route 93462
Pharmacologic agent administration 93463
Physiologic exercise study 93464

By Laureen Jandroep, CPC, CPC-I, CMSCS, CHCI ~ Instructor (888) 226-5799
www.CodingCertification.org HelpDesk@CodingCertification.org

If congenital then you are going to have one code for the
catheterization (93530-93533) and contrast injection(s) are
coded separately with 93563-93568.
If diagnostic angiography is performed during the same session as
therapeutic intervention, append the -59 modifier to the S&I codes.
S&I codes are not used to report post intervention injections in the
coronary vessels to determine level of effectiveness. These
injections and S&I are included in the valuation of the intervention
codes and not reported separately.
(AMA CPT Changes 2011: An Insider’s View)

I covered cardiovascular stents and other therapeutic
interventions twice before. Here are links to those video clips:
1

CPT Stents and Cardiac Cath Coding Tips- Bubble and Highlighting ...

2

Medical Coding Help- Cardiovascular Stents

So now for the questions:
patient #1- Dr. did 93459 and stent/ivus/lad, and descending
aortogram
patient #2 Dr. did 93459- stent/ivus/ffr/lad
Definitions:
1 93459 - see table above - left heart cath...

By Laureen Jandroep, CPC, CPC-I, CMSCS, CHCI ~ Instructor (888) 226-5799
www.CodingCertification.org HelpDesk@CodingCertification.org

2 LAD = left anterior descending (coronary) artery.
3 IVUS = intravascular ultrasound (allows us to see a coronary
artery from the inside-out.)
a Great explanation at Angioplasty.Org
b 92978 - Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation and/or
therapeutic intervention including imaging supervision, interpretation and report; initial vessel
(List separately in addition to code for primary procedure)

4 Stent = 92980 - Transcatheter placement of an intracoronary stent(s), percutaneous, with or
without other therapeutic intervention, any method; single vessel

5 descending aortogram - I would need to see report but I
suspect this is more to evaluate the access site and is
therefore bundled.
6 FFR - fractional flow reserve (from 2nd question)
a 93571-26 for initial vessel and 93572-26 for additional

vessel

By Laureen Jandroep, CPC, CPC-I, CMSCS, CHCI ~ Instructor (888) 226-5799
www.CodingCertification.org HelpDesk@CodingCertification.org