Medical Coding for Coronary Angiography – An Overview

by | Published on Sep 6, 2018 | Resources, Medical Coding News (A) | 0 comments

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Coronary angiography is a procedure generally done to find out whether blood flow to and from the heart is blocked or restricted. This is an imaging test that uses X-rays to view your body’s blood vessels (arteries) that supply blood to your heart muscles. The X-rays provided by an angiography are called angiograms. In general, coronary arteries can become narrowed by the buildup of plaque (which is an accumulation of cholesterol and other substances). Plaque buildup can reduce the amount of oxygen-rich blood flow into your heart through the arteries. By performing coronary angiography, physicians can find out how many arteries are blocked or enlarged. This in turn can help physicians determine the extent and severity of heart disease (if any) and develop the most appropriate treatment plan for the same. Cardiologists and general physicians performing angiography and other related procedures must report the same on their medical claims using the correct medical codes. Medical coding outsourcing is a practical option to handle coding challenges and claim submissions, which also impacts quality and reimbursement.

Also known as a cardiac angiogram or catheter arteriography, coronary angiography includes a general group of procedures known as heart (cardiac) catheterizations. Cardiac catheterization procedures can both diagnose and treat heart and blood vessel conditions. A coronary angiogram, which can help diagnose heart conditions, is one of the common types of cardiac catheterization procedures. Other coronary angiography procedures include – angioplasty, blood clot removal, stent placement and non-invasive coronary angiography (which use CT/MRI/Ultrasound to produce the angiogram).

Why a Coronary Angiogram Is Done

Coronary angiography is normally performed if you have, or are suspected to have, a coronary heart disease. Consulting physicians or cardiologists may recommend having the test if you have –

  • Symptoms of coronary artery disease, such as chest pain (angina)
  • Atherosclerosis (narrowing of the arteries)
  • Other blood vessel problems or a chest injury
  • New or increasing chest pain (unstable angina)
  • Brain aneurysm (a bulge in a blood vessel in your brain)
  • Blood clots or a pulmonary embolism (a blockage in the artery supplying your lungs)
  • Abnormal results on a noninvasive heart stress test
  • A heart valve problem that requires surgery
  • A heart defect you were born with (congenital heart disease)
  • Pain in the jaw, chest, neck or arm that can’t be explained by other tests

As with any other medical tests, there are some risks associated with the condition, although serious problems are rare. The potential risk factors include – injury to the artery or vein, blood clots, bleeding or bruising, stroke, irregular heart rhythms (arrhythmias), heart attack, infections and other allergic reactions to the dye or medications (used during the procedure). It is important for patients to have a detailed discussion with physicians regarding any questions or concerns that they have about the angiography procedure.

Preparing for Coronary Angiography – What the Procedure Involves

The procedure is normally performed in a hospital X-ray or radiology department. Before initiating the procedure, physicians may conduct a detailed evaluation of the patient’s previous medical history wherein they will enquire about various medicines consumed and whether they have any allergies/reactions to any specific medications or contrast dye in the past. A detailed physical examination and several tests – blood tests, electrocardiogram (ECG), chest X-ray, MRI or a CT scan may be conducted before a coronary angiography, in an effort to identify problems with your heart. In addition, the blood pressure and blood sugar level will also be closely monitored before starting the procedure.

As part of their preparation for undergoing an angiography, patients may be asked to follow certain guidelines which include –

  • Don’t eat or drink 8-12 hours before the angiogram
  • Inform your physicians about the normal medicines and other vitamin supplements that you are currently consuming (as some substances can directly interfere with the procedure)
  • Diabetic patients should take permission from the physician to take insulin or other oral medications before the angiogram.

Before the procedure, patients will be given a mild sedative through the IV line (inserted in to a vein in the arm) that helps them relax. Physicians will clean and numb an area of the body in the groin or arm with an anesthetic. A small incision will be made at the area and a long, thin, flexible tube (catheter) is inserted into the artery. The catheter is inserted through the sheath into the blood vessels and carefully threaded to the heart or coronary arteries. Threading the catheter should not cause any pain, and patients shouldn’t feel it moving through their body.

A dye (contrast material) is directly injected through the catheter. Patients may feel a slight burning or “flushing” sensation after the dye is injected. The dye is easy to see on X-ray images. As it moves through the blood vessels, physicians observe its flow and identify any specific blockages or constricted areas in the arteries. Depending on the results of the angiogram, physicians may recommend additional catheter procedures at the same time, such as a balloon angioplasty or a stent placement to open up a narrowed artery. The test can take between 30 minutes and two hours, especially if it is combined with other cardiac catheterization procedures. Preparation and post-procedure care can add more time.

Cardiology medical coding can be complex. Cardiologists or thoracic surgeons performing various angiography procedures must use the relevant diagnosis and procedure codes to bill the procedure correctly. The following codes are used for medical billing purposes –

ICD-10 Codes

  • Z98.6 – Angioplasty status
  • Z98.61 – Coronary angioplasty status
  • Z98.62 – Peripheral vascular angioplasty status

CPT Codes to Use

  • 93451 – Right heart catheterization
  • 93452 – Left heart catheterization
  • 93453 – Right and left heart catheterization
  • 93454 – Coronary angiography
  • 93455 – Coronary angiography with bypass grafts
  • 93456 – Coronary angiography with right heart catheterization
  • 93457 – Coronary angiography and bypass grafts, with right heart catheterization
  • 93458 – Coronary angiography with left heart catheterization
  • 93459 – Coronary angiography and bypass grafts, with left heart catheterization
  • 93460 – Coronary angiography with right and left heart catheterization
  • 93461 – Coronary angiography with bypass grafts, right and left heart catheterization
  • +93462 – Left heart access via transseptal or transapical puncture
  • +93463 – Pharmacological agent administration with hemodynamic assessment
  • +93464 – Physiologic exercise study with hemodynamic assessment
  • 93503 – Placement of flow directed catheter for monitoring
  • 93505 – Endomyocardial biopsy
  • 93530 – Right heart catheterization for congenital cardiac anomalies
  • 93531 – Combined right & retrograde left heart cath for congenital cardiac anomalies
  • 93532 – Combined right &transseptal left heart cath through intact septum for congenital cardiac anomalies
  • 93533 – Combined right &transseptal left heart cath through existing septum opening for congenital cardiac anomalies
  • 93561 – Indicator dilution study with cardiac output (separate procedure)
  • 93562 – Indicator dilution study; subsequent measurement of cardiac output
  • +93563 – Injection/imaging for coronary angiography with cath for congenital anomaly
  • +93564 – Injection/imaging for bypass graft angiography with cath for congenital anomaly
  • +93565 – Injection/imaging for left heart angiography with cath for congenital anomaly
  • +93566 – Injection/imaging for right heart angiography with cath for congenital anomaly
  • +93567 – Injection/imaging procedure for supravalvular aortography
  • +93568 – Injection/imaging procedure for pulmonary angiography
  • +93571 – Intravascular coronary flow reserve measurement, initial vessel
  • +93572 – Intravascular coronary flow reserve measurement, each additional vessel
  • +92978 – Coronary vessel or graft imaging with IVUS or OCT, initial vessel
  • +92979 – Coronary vessel or graft imaging with IVUS or OCT, each additional vessel

Therapeutic / Interventional Procedures

  • 92920 – Angioplasty, single vessel
  • +92921 – Angioplasty, additional branch
  • 92924 – Atherectomy, single vessel
  • +92925 – Atherectomy, additional branch
  • 92928 – Stent, single vessel
  • +92929 – Stent, additional branch
  • 92933 – Atherectomy + stent, single vessel
  • +92934 – Atherectomy + stent, additional branch
  • 92937 – PCI of or through bypass, any method(s)
  • +92938 – PCI of or through bypass, additional branch
  • 92941 – PCI of acute MI, all interventions, single vessel
  • 92943 – PCI of chronic total occlusion, any method(s)
  • +92944 – PCI of chronic total occlusion, additional branch
  • +92973 – Percutaneous coronary thrombectomy, mechanical

Other Supportive Therapies

  • 92975 – Thrombolysis, coronary, by intracoronary infusion
  • 92977 – Thrombolysis, coronary, by intravenous infusion
  • 33967 – Insertion of intra-aortic balloon assist device, percutaneous
  • 33968 – Removal of intra-aortic balloon assist device, percutaneous
  • 33990 – Insert ventricular assist device (VAD), percutaneous, arterial access only
  • 33991 – Insert VAD, percutaneous, arterial & venous access, transseptal
  • 33992 – Remove ventricular assist device, at separate session from insertion
  • 33993 – Reposition ventricular assist device, with imaging, at separate session
  • G0269 – Placement of occlusive device into vascular access site

Once the procedure is completed, the catheter is removed from the arm or groin (to prevent bleeding) and the incision is closed with manual pressure, a clamp or a small plug. On the other hand, if the catheter was inserted in the groin, patients may be asked to lie flat on their back for a few hours after the test to prevent bleeding. Patients can leave the hospital the same day or may have to remain in the hospital overnight after completion of the procedure. Patients need to drink plenty of fluids after the test as this helps the kidneys to flush out the contrast dye.

Generally, angiography is a safe and painless procedure. Patients may feel a mild drowsiness (after the procedure) if they had sedative medications. A few days or weeks after the procedure, it is common for patients to experience soreness, tenderness and bruising at the catheter incision site. In some cases, a very small lump or collection of blood will be seen near the area where the incision was made. In addition, there is also a very small risk of other complications occurring, such as an allergic reaction to the dye or a stroke. Patients need to restrict their activities following a coronary angiography. Follow your physician’s instructions for eating and drinking and avoid strenuous activities and heavy lifting for several days.

Cardiology medical billing and coding can be complex and proper knowledge regarding appropriate coding and payer-specific medical billing guidelines are essential for correct and on-time reimbursement. The support of an experienced medical coding service provider can help in reporting the various angiography procedures correctly for optimal reimbursement.

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