Cardiac Catheterization Coding for Congenital Defects

Cardiac Catheterization Coding for Congenital Defects


Laureen: Q: “In reference to the CPC Blitz
Medicine Video covering Cardiac Caths for congenital defects, I understand they are
coded in 3 pars – cath, injection and imaging. However in the video, and in the guidelines,
I am confused as how to code for the imaging. Is it 93567 – add on code for supravalvular
aortography or is it coded from the radiology section. Also, could you point out where in the guidelines
or parenthetical notes it directs us to code the imaging? It seems so vague, I must be missing something!” A: OK! No, you’re not missing anything, it is truly
a bit confusing and it took me a while when you teach the same thing every year, like
you go through the CPT manual several times every year, and then they go and change it
majorly. It makes it so hard because you want to go
into how you’ve always taught it, you have to go, “Wait a minute, let me put the brakes
on and re-think that.” So, cardiac caths used to always be reported
in pieces, and if you think about what the cardiac cath is, it’s a diagnostic test
where they’re threading the catheter through the vessels near the heart to inject dye in
order to take a picture, to get a good image to see what is going on so that they can diagnose
the problem. So, those three pieces: the catheter manipulation,
the injection of the dye, and the imaging were all reported separately and your typical
run-of- the-mill heart cath had five codes. Then they decided to just bundle it all together. And the exception was – for the congenital
caths, those were still exploded out into their component parts. So, for the most part, the three pieces are
now bundled into single codes, the catheterization, the dye, and the imaging where the dye was
injected, those were all together in one code. There are exceptions and that is the congenital
heart caths. For those of you that code the injecting and
imaging separately; so those are done separately, if you turn to that section, in the Medicine
section of CPT. But the questionnaires specifically asked
about 93567, that’s an injection procedure during a cardiac catheterization including
imaging supervision, interpretation and report. And, here’s the key: for supravalvular aortography
(List separately in addition to code for primary procedure) – you can use it with congenital
caths but also some other caths. That’s where it gets confusing because you’re
like, “Wait, I thought the other ones, they only had one.” If you look at the parenthetical note below
it – and I always say this when I’m teaching for the Blitz Review –parenthetical notes
are your friend. Like, sometimes, parentheses in real life
are like they’re not even worthy of being in the sentence without a parenthesis. But, in CPT, it’s very valuable key information. In this case it’s telling you to use 93567
in conjunction with these other codes. Several of those are none congenital caths
and that’s where the confusion starts to come in. But, notice what it is actually for: imaging
of the aorta. It’s used for evaluating conditions such
as aortic regurgitation, aortic aneurysm or dissection and congenital anomalies of the
aorta – in other words it’s all about the aorta – whereas, the cardiac caths codes
are about the heart and the chambers. The imaging codes that are used for the heart
cath itself are included. Imaging of the aorta would be extra and is
ok to code separately with this code. That’s what it’s all about, so you’re
not going crazy.

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