Awareness : Did You Know? 2017

Did You Know? Weekly Educational Series 32

For the Week of May 2, 2016-Cardiology-Right Heart Cath

2016: This year, you’ll find this sentence added at the end: “The right heart catheterization (RHC) CPT® code may be billed only if a complete right heart catheterization procedure is performed. If an abbreviated right heart catheterization is medically reasonable and necessary, it may be Billed with CPT® code 93799 (Unlisted cardiovascular service or procedure).”

Takeaway: It would be extremely “unusual for a cardiologist to perform an ‘abbreviated’ right heart cath because all of the information that is obtained is vital to determining the patient’s treatment. To do less than the normal would be rare. Additionally, there needs to be strong supportive documentation for why the cardiologist thought the minimal RHC (93799, according to the CCI manual) was medically necessary. Use 93799 cautiously and provide a description explaining what the cardiologist did.  We recommend to use unlisted codes at a minimum.

Warning: Endomyocardial biopsy is a typical procedure following heart transplant. Experts advise that “post heart transplant” without further explanation is not sufficient to support billing both the RHC and biopsy at the same session. Medically necessary RHC at the same session as endomyocardial biopsy is rare. Terms like elective, periodic, routine, and surveillance for the RHC suggest the RHC is not billable as a diagnostic service. Also keep in mind that performing right atrial and ventricular pressures can be part of the standard protocol for the biopsy rather than being a true diagnostic RHC.

Bottom line: Don’t use the CCI manual’s language change as an excuse to start reporting RHCs that are not medically necessary diagnostic procedures. 2016: “CPT® codes 93600 (Bundle of His recording), 93602 (Intra-atrial recording), 93603 (Right ventricular recording), 93610 (Intra-atrial pacing), and 93612 (Intraventricular pacing) should not be reported with a code describing insertion or replacement of an electrode or device (pacemaker, defibrillator) because they are integral to the procedure. If a physician performs a medically reasonable and necessary limited diagnostic electrophysiology test preceding the insertion or replacement of the electrode or device to determine the necessity to proceed with insertion or replacement of an electrode or device, the appropriate CPT® codes describing the limited diagnostic electrophysiology testing may be reported with an NCCI-associated modifier. The limited diagnostic electrophysiology testing to determine the necessity to proceed with insertion or replacement of the electrode or device may be performed at the same or different patient encounter.”

Takeaway: The new language should help support coding for testing performed before lead replacement: It’s sometimes unclear to the physician whether the lead is malfunctioning or the device (pacemaker/ICD) itself is malfunctioning.” For example, you may be able to report 93600, 93602, 93603, 93610, or 93612 with device or lead replacement codes 33206-33208 for true diagnostic tests. Be sure to append modifier 59 (Distinct procedural service) to the diagnostic test code. In current practice, it’s rare for a cardiologist or interventional cardiologist to perform a limited diagnostic EP test before an electrode or device procedure. You’re more likely to see an electrophysiologist, who specializes in this type of service, perform the test.