EDITOR’S NOTE: The following is a physician’s perspective on the Sandy Brewton article, “LHC vs Coronary Angiography: Take Heart When Coding.”
I was one of those physicians who once thought a left heart catheterization was done with the coronary artery angiography procedure. That’s because, in the strictest, semantic sense of the phrase, it is. The MedlinePlus definition of “left heart catheterization” is “the passage of a thin flexible tube (catheter) into the left side of the heart. It is done to diagnose or treat certain heart problems.”
At first, I thought this was an example of a coding-clinical disconnect. Clinicians use language to communicate with one another regarding a patient’s care. The fact is that coders and billers and lawyers and auditors also read the practitioner’s documentation to fulfill their own specific purposes, and this can cause problems.
But as I thought about it more, I realized that isn’t precisely the issue. Coders do not really have a different definition of “left heart catheterization.” Confusion has arisen because coding guidelines and interpretations have labeled the hemodynamic measurements in the vessels and heart to evaluate left ventricular function erroneously as the procedure “left heart catheterization.” The real question is, should you be coding it?
In ICD-10-PCS coding, you code what was accomplished during a procedure. Interim and secondary necessary steps are often not captured separately. For instance, if a right colectomy is performed, the surgeon likely looks around in the peritoneal cavity prior to resection of the bowel, but you wouldn’t code an “inspection.” Similarly, the incision is often closed, but you would not code a repair of the abdominal muscles and wall, because it is integral to the intended procedure. You only code open resection of right colon.
If the procedure of a left heart catheterization, in the strict, semantic sense, is done to introduce the catheter in order to inject dye and fluoroscopically record the flow, you only code the fluoroscopy of the heart and/or coronary arteries. If pressure measurements are taken and recorded, then you must go to Measurement and Monitoring, Section 4. In current practice, this step is often supplanted by the non-invasive (and less risky) process of echocardiography. Ultimately, since the catheter is removed at the end of the procedure, there should not be any code capturing it, because temporary devices are not included in PCS character representation.
But aren’t we lucky that coders are permitted to interpret documentation and capture what was actually accomplished, not necessarily merely what the CPT clinical terminology documented by the provider is? You will never read a surgeon’s operative note informing you that he or she extirpated a thrombus, but you don’t need to. My recommendation is to look for what was actually accomplished. Ignore the phrase “left heart catheterization.” For example:
Measurements were taken and recorded:
Angiography performed:
Angioplasty? Stents?
The bottom line: Code what was done, not what was said!
As I discussed recently, we have a go-live date for the Medicare Change of Status Notice of Feb. 14. Before reading on, stop and take
The Centers for Medicare & Medicaid Services (CMS) released the Final Rule for the 2025 Medicare Physician Fee Schedule on Nov. 1, which included a
Please log in to your account to comment on this article.
Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
Copyright © 2025 RACmonitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
