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Getting on top of the new codes and pages of new guidelines this year's CPT introduced for cardiology is no easy task. Therefore to make it easy for you, here's a code-by-code as well as a briefing on when you shouldn't assign these codes on your claim. Begin here: The codes in spotlight are: 93451 - Right heart catheterization (RHC) including measurement(s) of oxygen saturation and cardiac output, when carried out 93452 93453 Tip: Right Heart Catheterization: 93451 applies to a narrow group Code 93451 approximately replaces 2010 code 93501 (RHC). However, prior to choosing new code 93451, you need to be sure you understand when it applies and the many cases when another code would be more apt. RHC defined: As per CPT guidelines, RHC includes cath placement in the right-sided cardiac chambers or structures. This includes the right atrium (RA), right ventricle (RV), pulmonary artery (PA), and wedge locations. According to CPT 2011 guidelines , RHC also includes taking blood samples to measure blood gases and measuring cardiac output if the doctor performs them. This may include oxygen saturations, wedge pressures, and thermodilution studies. Coding tip: Medical coders who had pre-2011 RHC, reviewed note that auditors wanted to see all right heart chambers and structures documented to support the RHC code. This means that if the doctor cannot enter one of the structures or chambers, he should explain briefly why to make the documentation complete. Beyond 93451: CPT includes an instruction under 93451 telling you not to report the code with 93453 (combined RHC and LHC) or with 93456, 93457, 93460, or 93461 (which all include RHC apart from other services). One more time you should stay away from reporting 93451 is if the RHC is for a congenital case. After this you should report 93530 (RHC, for congenital cardiac anomalies) in place of 93451. Bonus tips: According to CPT guidelines, you shouldn't report 93503 with 93451 or any other diagnostic cardiac cath codes. What's more, you should not append modifier 51 (multiple procedures) to 93451. And if you code manually, take extra care not to swap your digits. Left Heart Catheterization: 93452 Covers ventriculography, too If the cardiologist catheterizes only left heart structures, you will need to find out whether your 93452 is proper for your LHC case. Code 93452 roughly covers the same services you would have coded last year using 93510 and 93555. LHC defined: The main indicator for LHC is that the doctor crossed the aortic valve. According to CPT guidelines, LHC involves catheter placement in a left-sided (systemic) cardiac chamber(s) (left ventricle or left atrium) and includes left ventricular injection(s) when carried out." Also it includes taking left ventricular pressures. This means left ventriculography injection, supervision, interpretation and report are all included when performed. Consequently, you should not report +93565 in addition to 93452. Report separately: Even though CPT includes multiple services in 93452, there are some services you may report separately. In some instances, the cardiologist may carry out LHC using a transapical puncture of the left ventricle or a transseptal puncture when the septum is intact. CPT guidelines instruct that in that case, apart from the appropriate LHC code, such as 93452, you should report +93462. More comprehensive options: Be sure to watch for cases where a code that is more comprehensive than 93452 is proper. Particularly, CPT instructs you not to report 93452 with 93453 (RHC and LHC) or 93458-93461 which specify that they include LHC along with coronary angiography and other services. 93453 brings 93451 and 93452 together The services 93453 describe would in effect have been covered by 93526, 93543 and 93555 (imaging S&I) last year. Since the procedure involves LHC, remember that the key identifier for that procedure is that the physician crossed the aortic valve. Code 93453 involves both RHC and LHC as such once you understand when 93451 is proper for an RHC service and 93452 is proper for an LHC service, you are well on your way to mastering when to report 93453. Many of the same rules apply, as do many of the same restrictions. For more on this and for other cardiology coding updates, stay tuned to a medical coding guide like Supercoder. For More Read :- Part 2: 93451-93453: Put This Code-Specific Primer to Work for Your Claims
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