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LA recording (93621)

Long Posted Wed 23rd of October, 2019 20:10:02 PM
My doctor has performed an EP study procedure, and placed a catheter in CS. No pacing is done in the procedure and the doctor also did not document any specific data collected in the procedure (e.g., atrium ERP). Can we still bill 93621 for LA recording? Or should we just bill 36011 in this case?
SuperCoder Answered Thu 24th of October, 2019 04:07:58 AM

Hi Long,

 

Unlisted CPT code 93799 (Unlisted cardiovascular service or procedure) would be the appropriate CPT code to use for placement of catheter in coronary sinus. If provider has performed electrophysiologic study (atrial recording) along with placement of CS catheter, then CPT code 93621 with 52 modifier for reduced services would be the appropriate code of choice.

 

Please find below SuperCoder newsletter for more information:

 

https://www.supercoder.com/coding-newsletters/my-anesthesia-coding-alert/bust-3-cs-catheter-myths-to-skip-the-wrong-code-article

 

Thanks! 

Long Posted Thu 24th of October, 2019 15:10:07 PM
I understand that we should report 93621 if pacing was done at LA or CS site in the procedure. We also know that we should report 93621-52 if catheters have been placed at LA or CS sites and data (e.g., Atrial ERP) has been recorded in the procedure, but no pacing was done at LA or CS sites. The question is what CPT code we should report if catheters have been placed at LA or CS sites but no data such as Atrial ERP has been recorded (thus no atrial recording?) in the procedure. Should we still report 93621-52? You seem to suggest 93799 in this case, just to confirm. Why 93799, not 36011, for catheter placement?
SuperCoder Answered Fri 25th of October, 2019 02:58:13 AM

Hi Long,

 

CPT code 36011 would not be the appropriate code for placement of catheter in coronary sinus. Catheterization coding is done based on the vascular tree (Families) model. Coronary sinus is not listed as the first order code in the vascular family’s tree model. Moreover, we did not come across any guidelines which states this code can be an appropriate code for CS catheterization. Hence it would not be appropriate to use this code. 

 

As stated earlier, Unlisted CPT code 93799 would be best possible code to use in this scenario. We have already shared the SuperCoder newsletter regarding the same which states CPT code 93799 as the appropriate CPT code for CS Catheterization.

 

Thanks!

Long Posted Fri 25th of October, 2019 14:57:42 PM
Got it, thank you!
SuperCoder Answered Tue 29th of October, 2019 00:46:26 AM

Thank you, happy to help.

Long Posted Wed 30th of October, 2019 16:04:01 PM
BTW, can you send me the newsletter (https://www.supercoder.com/coding-newsletters/my-anesthesia-coding-alert/bust-3-cs-catheter-myths-to-skip-the-wrong-code-article)? The link does not work for me.
SuperCoder Answered Thu 31st of October, 2019 01:44:56 AM

Here you go,

Your doc needs to do this to get paid on more than CS cath placement .

Quick -- look up the CPT code for coronary sinus (CS) catheter placement used during cardiac surgery. No luck? Then an unlisted code reporting is in your future.Here are the whys and hows on this unique procedure.

Myth 1: Code 93508 Applies to CS Cath Fact: Code 93508 (Catheter placement in coronary artery[s], arterial coronary conduit[s], and/or venous coronary bypass graft[s] for coronary angiography without concomitant left heart catheterization) does not apply to coronary sinus catheter placement, even if you append modifier 52 (Reduced services). In addition, the 936xx range of codes (those for EP studies) are inappropriate.Instead, an unlisted code is your best choice.

Anesthesiologists insert coronary sinus catheters for minimally invasive heart valve surgery, says Farhan Sheikh, MD, professor of anesthesiology and director of cardiac anesthesia at Albany Medical Center. The coronary sinus is inserted with a catheter to deliver retrograde cardioplegia solution with TEE guidance, not for monitoring or angiography purposes.

Coronary sinus pressure is monitored when the retrograde cardioplegia solution is being injected into it, but not for any other reason. Although many centers still perform the procedure, there are now less invasive means to accomplish the same patient safety goals.

Myth 2: Cath Intro Is Way to Go

An ASA teleconference in Nov. of 2008 recommended 36013 (Introduction of catheter, right heart or main pulmonary artery) for this CS cath placement. Joanne Mehmert, CPC, an independent consultant from Kansas City, Mo., disagrees, saying that currently, no CPT code describes placement of a coronary sinus catheter used during surgery.

Fact: Code 93799 (Unlisted cardiovascular service or procedure) is the best code to use for coronary sinus catheter placement for all uses except left ventricular pacing, according to CPT Assistant (April 2009). Following electronic submission of the claim, send in supporting documentation such as a procedure report describing of the procedures need and the services necessary time, effort, and equipment. In your cover letter, include a CPT reference code, like 36013, to help the insurer value the unlisted procedure code. Explain that the cath introduction procedure has similar work, malpractice risk, and practice expense as the procedure that the unlisted procedure code represents.

Myth 3: You Cant Capture Guidance

Your anesthesiologist might have to add services to ensure patient safety during CS cath placement. With proper documentation, you might get paid for guidance and more.

Doctors reporting in the medical journal Chest concluded that placement of a CS catheter can cause minor myocardial damage in about 9 percent of patients. Such damage may not be clinically evident, and only observed after thoracotomy.

CS oxygen saturation, CS flow, distal tip pressure, and fluoroscopy are reliable tools to assess a safe and correct positioning of the CS catheter, the authors say. To get paid on these items, make sure your physicians documents are crystal clear on every aspect of the placement he participated in.

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