Diagnostic & Therapeutic Cardiac Catheterization Coder 2017 Including peripheral and cardiovascular services and procedures Prepared and Published By: MedLearn Publishing A Division of Panacea Healthcare Solutions, Inc. 287 East Sixth Street, Suite 400 St. Paul, MN 55101 1-800-252-1578 www.panaceainc.com
Introduction...1 Sedation Services Moderate (Conscious) Sedation... 7 Cardiac Catheterization A Note About Modifier Assignment Before We Begin... 11 Right Heart Catheterization... 11 Right Heart Catheterization with Coronary Angiography... 13 Right Heart Catheterization with Coronary and Bypass Graft Angiography (including SVG and IMA)... 14 Left Heart Catheterization... 15 Left Heart Catheterization With or Without Left Ventriculogram... 15 Left Heart Catheterization With or Without Left Ventriculography and Coronary Angiography... 16 Left Heart Catheterization With or Without Left Ventriculography, Coronary Angiography and Bypass Graft Angiography (Including SVG and/or IMA)... 17 Right and Left Heart Catheterization... 17 Right and Left Heart Catheterization With or Without Left Ventriculography... 18 Right and Left Heart Catheterization With or Without Left Ventriculography and Coronary Angiography... 18 Right and Left Heart Catheterization With or Without Left Ventriculography, Coronary Angiography and Bypass (Including SVG and/or IMA) Angiography... 19 Congenital Heart Catheterization... 20 Coronary and/or Bypass Graft Angiography (including SVG and/or IMA) Performed Without Concomitant Left Heart Catheterization Procedure... 21 Coronary and Bypass Graft (including SVG and/or IMA) Angiography Without Concomitant Left Heart Catheterization... 21 Injection Procedures for Congenital Cardiac Catheterization... 22 Coronary Angiography When Performed With Congenital Cardiac Catheterization... 22 Bypass Graft Angiography (Including SVG, IMA and radial) With Congenital Cardiac Catheterization... 22 Left Ventricular or Left Atrial Angiography Performed with Congenital Cardiac Catheterization... 22 Injection Procedures for Cardiac Catheterization... 23 iii
Right Ventricular or Right Atrial Angiography Performed with Cardiac Catheterization... 23 Supravalvular Aortography (Aortic Root Injection) Performed with Cardiac Catheterization... 23 Pulmonary Angiography Performed with Cardiac Catheterization... 23 Swan-Ganz Placement... 24 Left Heart Catheterization by Transseptal or Transapical Puncture... 24 Pharmacologic Agent Administration... 26 Physiologic Exercise Study...28 Intravascular Doppler Flow Reserve Measurement... 29 Renal Artery Angiography (Non-Selective) During Cardiac Catheterization... 30 Iliac and/or Femoral Artery Angiography (Non-Selective) During Cardiac Catheterization... 30 Vascular Closure Devices... 31 Low Osmolar Contrast Media/Non-Ionic Contrast... 31 Ambulatory Blood Pressure Monitoring... 33 Cardiopulmonary Resuscitation... 33 Cardiac Catheterization Procedures and Codes... 34 Coronary Interventions: Stenting, Angioplasty and Atherectomy of Major Coronary Arteries, Coronary Artery Branches and Bypass Grafts Coronary Interventions... 35 Percutaneous Transluminal Coronary Angioplasty... 40 Percutaneous Transluminal Coronary Atherectomy... 40 Intracoronary Stent Placement (Bare Metal or Drug-Eluting)... 41 Combination (Multiple Interventions) Codes... 43 Interventions Within Bypass Graft or Through Graft... 44 Interventions for Acute Total/Subtotal Occlusion During Myocardial Infarction (MI)... 45 Interventions for Chronic Total Occlusion (CTO)... 48 Modifier Assignment... 49 Coding Examples...49 Valvuloplasty... 55 T-Wave Alternans... 55 Cardioassist-Method of Circulatory Assist During Coronary Interventions (VAD)... 55 Cardiac Assist Devices (VAD)... 56 Aortic Valves... 57 iv
Cardiopulmonary Bypass Support... 58 Intra-Aortic Balloon Assist/Intra-Aortic Balloon Pump (IABP)... 59 Transcatheter Mitral Valve Repair... 60 Coronary Thrombectomy and Intravascular Brachytherapy... 62 Endoluminal Imaging of Intracoronary Vessel or Graft... 63 Repair of Septal Defect... 64 Repair of Structural Heart Defect (Transcatheter Closure of Paravalvular Leak)... 66 Intravascular Catheter-Based Coronary Vessel or Graft Spectroscopy... 67 Percutaneous Transcatheter Closure of the Left Atrial Appendage... 69 Wireless Pressure Sensor Implantation... 69 Coronary Interventional Procedures and Codes... 69 Cardiovascular Illustrations and Guidelines...71 Frequently Asked Questions Related to Cardiac Catheterization Coding...83 Selective Catheter Coding (Non-Cardiac Procedures) Component Coding Rules, Regulations and Definitions... 89 Vascular Family... 90 Catheter Placements... 92 Component Coding Rules... 93 Transcatheter Therapy Rules... 97 Angiographic Radiology of the Head, Neck and Chest... 102 Coding Tips... 105 Interventional Radiology of the Head, Neck and Chest... 107 Coding Tips... 108 Angiographic Radiology of the Abdomen... 121 Coding Tips... 121 Interventional Radiology of the Abdomen... 123 Coding Tips... 123 Angiographic Radiology of the Upper Extremities... 126 Coding Tips... 127 Interventional Radiology of the Upper Extremities... 129 Coding Tips... 129 v
Angiographic Radiology of the Lower Extremities... 132 Coding Tips... 135 Interventional Radiology of the Lower Extremities... 137 Coding Tips... 142 ICD-10 Coding System...157 Case Studies...159 Appendix A 2017 Medicare Payment Rates... 195 MPFS Status Codes... 222 Hospital OPPS Status Indicators... 224 Appendix B Modifiers... 227 CPT Modifiers... 227 HCPCS Level II Modifiers... 238 Sample Charge-Capture Tools Diagnostic Angiography Procedures... 239 Interventional Radiology Procedures... 240 References...243 vi