CPT Code Details

Transcription

1 CPT Code Details Code Descriptor Intravascular Doppler velocity and/or pressure derived flow reserve measurement ( vessel or graft) during angiography pharmacologically induced stress; each additional vessel (List separately in addition to code for primary procedure) Notes: (Use in conjunction with 93571) (Intravascular distal blood flow velocity measurements include all Doppler transducer manipulations and repositioning within the specific vessel being examined, during angiography or therapeutic intervention [eg, angioplasty]) (For unlisted cardiac procedure, use 93799) (Do not report in conjunction with 0523T) Lay Term In this procedure, the provider passes a catheter into a vessel or bypasses graft and injects a medication that increases blood flow. He then measures the blood s velocity and pressure using the Doppler method to determine the extent of a blockage in each additional vessel. Modifier Explanation In this procedure, the provider passes a catheter into a vessel or bypasses graft and injects a medication that increases blood flow. He then measures the blood s velocity and pressure using the Doppler method to determine the extent of a blockage in each additional vessel. After the provider performs a percutaneous procedure on a vessel, he attaches a Doppler ultrasound transducer to a guide wire and advances it through the existing catheter. He measures the blood flow and then administers a stress agent. He takes another measurement and then compares the two measurements. Tips This code represents the procedure performed on an additional vessel. It must be reported with the primary code, 93571, Intravascular Doppler velocity and or pressure derived flow reserve measurement, vessel or graft, during angiography pharmacologically induced stress, initial vessel; list separately in addition to code for primary procedure. CPT Guidelines Range Specific Guideline

2 All injection codes include radiological supervision, interpretation, and report. Cardiac codes ( ), other than those for congenital heart disease, include contrast typically performed during these procedures (see Cardiac ization above). Do not report in conjunction with When injection procedures for right ventricular, right atrial, aortic, or pulmonary angiography are performed in conjunction with cardiac, these services are reported separately ( ). When right ventricular or right atrial angiography is performed at the time of heart, use with the appropriate code (93451, 93453, 93456, 93457, 93460, or 93461). Use when supravalvular ascending aortography is performed at the time of heart. Use with the appropriate right heart code when pulmonary angiography is performed. Separately reported injection procedures do not include introduction of catheters but do include repositioning of catheters when necessary and use of automatic power injectors, when performed. When contrast injection(s) are performed in conjunction with cardiac for congenital cardiac anomalies ( ), see Injection procedure codes include supervision, interpretation, and report. Injection procedures represent separate identifiable services and may be coded in conjunction with one another when appropriate. The technical details of supervision of and processing, interpretation, and report are included. Section Specific Guideline Cardiac is a diagnostic medical procedure which includes introduction, positioning and repositioning, when necessary, of catheter(s), within the vascular system, recording of intracardiac and/or intravascular pressure(s), and final evaluation and report of procedure. There are two code families for cardiac : one for congenital heart disease and one for all other conditions. Anomalous arteries, patent foramen ovale, mitral valve prolapse, and bicuspid aortic valve are to be reported with , Right heart includes catheter one or more right-sided cardiac chamber(s) or structures (ie, the right atrium, right ventricle, pulmonary artery, pulmonary wedge), obtaining blood samples for measurement of blood gases, and cardiac output measurements (Fick or other method), when performed. Left heart involves catheter a -sided (systemic) cardiac chamber(s) ( ventricle or atrium) and includes ventricular injection(s) when performed. Do not report in conjunction with other diagnostic cardiac codes. When right heart is performed in conjunction with other cardiac services, report 93453, 93456, 93457, 93460, or For placement of a flow directed catheter (eg, Swan-Ganz) performed for hemodynamic monitoring purposes not in conjunction with other services, use Right heart does not include right ventricular or right atrial angiography (93566). When heart is performed using either transapical puncture of the ventricle or transseptal puncture of an intact septum, report in conjunction with 93452, 93453, , 93653, placement(s) in artery(ies) involves selective engagement of the origins of the native artery(ies) for the purpose of angiography. placement(s) in bypass graft(s) (venous, internal mammary, free arterial graft[s]) involve selective engagement of the origins of the graft(s) for the purpose of bypass angiography. It is typically performed only in conjunction with angiography of native vessels. The cardiac codes ( ), other than those for congenital heart disease, include contrast injection(s), supervision, interpretation, and report for typically performed. Codes for heart (93452, 93453, ), other than those for congenital heart disease, include ventricular/ atrial supervision, and interpretation, when performed. Codes for catheter placement(s) ( ), other than those for congenital heart disease, include supervision, and interpretation. Codes for catheter placement(s) in bypass graft(s) (93455, 93457, 93459, 93461), other than those for congenital heart disease, include

3 bypass graft supervision, and interpretation. Do not report in conjunction with For cardiac for congenital cardiac anomalies, see When contrast injection(s) are performed in conjunction with cardiac for congenital anomalies, see Cardiac ( ) includes all roadmapping angiography in order to place the catheters, any injections and supervision, interpretation, and report. It does not include contrast injection(s) and supervision, interpretation, and report for that is separately identified by specific procedure code(s). For right ventricular or right atrial angiography performed in conjunction with cardiac for congenital or noncongenital heart disease ( , ), use For aortography, use For pulmonary use For angiography of non arteries and veins, performed as a distinct service, use appropriate codes from the Radiology section and the Vascular Injection Procedures section. When cardiac is combined with pharmacologic agent administration with the specific purpose of repeating hemodynamic measurements to evaluate hemodynamic response, use in conjunction with and Do not report for intra administration of pharmacologic agents during percutaneous interventional procedures, during intra assessment of pressure, flow or resistance, or during intra procedures. Do not report in conjunction with , 92975, When cardiac is combined with exercise (eg, walking or arm or leg ergometry protocol) with the specific purpose of repeating hemodynamic measurements to evaluate hemodynamic response, report in conjunction with , , and Contrast injection to image the access site(s) for the specific purpose of placing a closure device is inherent to the procedure and not separately reportable. Closure device placement at the vascular access site is inherent to the procedure and not separately reportable. Modifier 51 should not be appended to 93451, 93456, Table of Cardiac ization Codes Placement Type Add-on Procedures (Can Be Reported Separately)

4 Coronary CPT Code Code Descriptor RHC LHC Bypass Artery Graft(s) Placement With Transseptal With With or Pharmacological Exercise Transapical Study Study Puncture Injection Procedure for Selective Injection Right Ventricular or Right Atrial Angiography Procedure for Supravalvular Aortography Injection Procedure for Pulmonary Angiography Right heart measurement(s) of oxygen saturation and cardiac output, when performed Left heart interpretation, when performed Combined right and heart interpretation, when performed 93454

5 93455 with catheter placement(s) in bypass graft(s), (internal mammary, free arterial venous grafts) bypass graft angiography with right heart

6 93457 with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) bypass graft angiography and right heart with heart when performed

7 93459 with heart when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography with right and heart when performed

8 93461 with right and heart when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography ICD-9 Vol 1 Crossref , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 411.0, 411.1, , , 413.0, 413.1, 413.9, , , , , , , , , , , , 414.2, 414.3, 414.4, 414.8, 414.9, , Fee Schedule Medicare Fees National Adjusted 26 TC 53 Facility Non Facility RVU - Nonfacility

9 National Adjusted 26 TC 53 Work RVU: PE RVU: Malpractice RVU: Total RVU: RVU - Facility National Adjusted 26 TC 53 Work RVU: PE RVU: Malpractice RVU: Total RVU: Global & Other Info Global Split Preoperative %: 0 Intraoperative %: 0 Postoperative %: 0 Total RVU: 0 Global Period (days): ZZZ Radiology Diagnostic Tests : 99 Code Status : C PC/TC Indicator : 1 Endoscopic Base Code : None Medically Unlikely Edit (MUE) : None Modifier Guidelines Modifier Rules(Click on rules for Details) MULT PROC 51 No multiple procedure payment adjustment BILAT SURG 50 No 150% bilateral payment boost ASST SURG 80 Assistant payment allowed when supported CO-SURG 62 Co-surgeons not permitted TEAM SURG 66 Team surgeons not permitted

10 MINIMUM ASST SURG 81 Assistant payment allowed when supported. ASST SURG (QUALIFIED RESI. NA) 82 Assistant payment allowed when supported. PHYSICIAN SUPERVISION *PS Concept does not apply. MUE Medically Unlikely Edits Source: 2017 Medically Unlikely Edits (MUE) Publisher: CMS Date: April 01, 2017 Services MUE MAI MUE Rationale Practitioner Services 2 3 Clinical: Data DME Suplier Services NA NA NA Facility Outpatient Services 2 3 Clinical: Data