Heart / Cardiac Catheterization Coding Left/Right

CPT coding of cardiac catheterizations is quite easy. There are a limited set of codes that are to be used. Let us first understand what is done during cardiac catheterization.

The physician accesses the femoral artery and passes the catheter with/without gudewire to reach the aorta and may/maynot perform aorogram. Then the cathter is reached to LCA ostium and coronary angiography is performed. The physican then performs ventriculogram. For angiographies first contrast injections are performed followed by radiologic imaging. The physician also takes reading various heart readings for which no codes are requied.

CPT coding of cardiac catheterization involves codes for cardiac catheterizations, injections and angiograms i.e. radiologic supervision and interpretation.

Get your cath code first—it will most frequently be either of the following:

Right heart catheterization (93501 which will start from the femoral vein)
(37.21) (88.52)
Left heart catheterization (93510 which will start from the femoral artery)
(37.22) (88.53)
Combined left and right heart catheterization (93526 which will include the femoral artery and vein)
(37.23) (88.54)

CPT codes for cardiac injection (93539-93545)
There are specific codes for bypass arteries or native main arteries (e.g. mammary)
(93539 don’t append modifier-51)
(88.55 or 88.56)
bypass veins (93540 don’t append modifier-51),
(88.55 or 88.56)
native arteries and veins; also called coronary angiography (93545
don’t append modifier-51)
(88.55 or 88.56)
as well as aortography (93544
don’t append modifier-51 ) for the aorta
(88.42)
and heart chambers: the ventricles and atria; also called ventricular or atrial
angiography (93542; 93543 append modifier-51 )

(88.52, 88.53, or 88.56)

- then your S&I codes (93555-93556
don’t append modifier-51
)
(included in 88.52-88.56)
93555 goes with 93542 and 93543 only representing the heart chambers
93556 goes with all the other injection codes.

For ICD-9-CM coding of the injection and imaging portion of the cardiac cath:
First of all, note that procedures classified to 89.6x are not coded with cardiac
cath
You use only 88.55 or 88.56 for all coronary vessel imaging—there is no
distinction made between the different types of coronary vessels and bygrafts. In most
cases, a two catheters are referenced (88.56), but if only one catheter is referenced, you
would use 88.55.

For the heart chambers, you use one code for the right heart structures in a right
heart cath (88.52), one code for the left heart structures in a left heart cath (88.53), and
one code for combined heart structures in a combined heart cath (88.55).

Common Cardio Abbreviations:
LIMA: left internal mammary artery
OM: obtuse marginal artery
ICA: intercranial/internal carotid artery
ECA: extracranial/external carotid artery
CCA: common carotid artery
SVC: superior vena cava
IVC: inferior vena cava

Don’t forget modifiers to identify coronary arteries and recall that any branches of
these arteries are not recognized for separate CPT code reporting:
LC—left circumflex coronary artery
RC—right coronary artery
LD—left anterior descending artery


Final Tips:


Note: a left heart cath must include the catheter passing the aortic valve into the left heart
chambers, otherwise code 93508 should be used. You must also note the approach when
considering your initial cath codes: there are several others types of left heart caths codes
and combined types of cath codes such as retrograde by cutdown (93511) for a left heart
cath and left ventricular puncture for a left heart cath (93514) and for a combined heart
cath (93528).

If contrast is used, be sure that it is captured via chargemaster or otherwise—this is
separately reimbursed. Codes most likely will be Q9949 or Q9950 based on the specified
type of material. Be sure to report the proper number of units used. Other supplies are