Cardiology Question for the Week of February 18, 2019

Question:

A question came from the director of our cardiovascular services (CVS) department today.  When a right heart catheterization is done to aid in the placement of a CS lead, is that reported separately?  Our dictation only briefly gives findings of RA and LA pressures.  We also do an angiogram with the right heart cath.  If it is something we can bill for, can you please advise what would need to be included in the dictation? We are not required to add a modifier on the RHC code.

Answer:

According to Chapter 5 of the National Correct Coding Initiative Policy Manual for Medicare Services, you cannot bill the RHC. It says the following:

“Many Pacemaker/Implantable Defibrillator procedures (CPT codes 3320233249) and Intracardiac Electrophysiology procedures (CPT codes 93600-93662) require intravascular placement of catheters into coronary vessels or cardiac chambers under fluoroscopic guidance. Physicians shall not separately report cardiac catheterization or selective vascular catheterization CPT codes for placement of these catheters. A cardiac catheterization CPT code is separately reportable if it is a medically reasonable, necessary, and distinct service performed at the same or different patient encounter. Fluoroscopy codes (e.g., CPT code 76000) are not separately reportable with the procedures described by CPT codes 33202-33249 and 93600-93662. Fluoroscopy codes intended for specific procedures may be reported separately.”

Additionally, ultrasound guidance is not separately reportable with these CPT codes. Physicians shall not report CPT codes 76937, 76942, 76998, 93318, or other ultrasound procedural codes if the ultrasound procedure is performed for guidance during one of the procedures described by CPT codes 33202-33249 or 93600-93662. CPT code 76001 was deleted January 1, 2019. Insertion or replacement of a temporary transvenous cardiac electrode or pacemaker catheter (CPT codes 33210, 33211) during a pacemaker/implantable defibrillator procedure (CPT codes 33202-33249) or intracardiac electrophysiology procedure (CPT codes 93600-93662) is not separately reportable. CPT codes 33210 and 33211 include the “separate procedure” designation in their code descriptors and are not separately reportable with another surgical procedure performed in the same anatomic area at the same patient encounter.”