The following services are included in cardiac catheterization and coronary angiography, and should not be separately billed to Medicare: However, when billing for a diagnostic cardiac catheterization or angiography, which has not been previously performed, but now is performed on the same day as a separate procedure prior to percutaneous coronary intervention, then the 59 modifier should be appended to the codes 93454 – 93461 as appropriate. The modifiers are RC: right coronary artery, LC: left circumflex coronary artery, LD: left anterior descending coronary artery, LM: left main coronary artery, and RI: ramus intermedius.Ĭlaims for these services billed without the major artery modifier will be returned to the provider as unprocessable.Ĭoronary angiography procedures, performed during a therapeutic coronary artery procedure, that are integral parts of the procedure (e.g., guiding arteriograms), are considered to be part of the percutaneous coronary intervention and not separately reportable diagnostic procedures. When billing for CPT codes 92978, 92979, 9352, use the coronary artery modifier to identify which vessel is undergoing a specific procedure. The CPT code(s) for the cardiac catheterization procedure(s), coronary angiography, and injection procedure(s) should be linked to the appropriate ICD-10-CM diagnosis code(s) that describes the indication for the procedure on the claim. The diagnosis code(s) must best describe the patient’s condition for which the service was performed.Ī primary diagnosis of ICD-10-CM code Z09 (encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm) and a secondary diagnosis of ICD-10-CM code Z94.1 (heart transplant status) should be used for patients post-heart transplant requiring follow-up cardiac catheterization and not showing evidence of rejection.Īdd the ICD-10-CM code for the underlying disorder (cause) for ICD-10-CM codes I25.82 (chronic total occlusion of coronary artery) and I31.4 (cardiac tamponade). Refer to NCCI and OPPS requirements prior to billing Medicare.įor services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.Ī claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. This article contains coding and other guidelines that complement the local coverage determination (LCD) for Cardiac Catheterization and Coronary Angiography. Not endorsed by the AHA or any of its affiliates. Presented in the material do not necessarily represent the views of the AHA. Preparation of this material, or the analysis of information provided in the material. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness orĪccuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the Resale and/or to be used in any product or publication creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions Īnd/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is onlyĪuthorized with an express license from the American Hospital Association. Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. AHA copyrighted materials including the UB‐04 codes andĭescriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may beĬopied without the express written consent of the AHA. All rights reserved.Ĭopyright © 2023, the American Hospital Association, Chicago, Illinois. The AMA assumes no liability for data contained or not contained herein.Ĭurrent Dental Terminology © 2022 American Dental Association. The AMA does not directly or indirectly practice medicine or dispense medical services. Applicable FARS/HHSARS apply.įee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not AMA CPT / ADA CDT / AHA NUBC Copyright StatementĬPT codes, descriptions and other data only are copyright 2022 American Medical Association.
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