How To Code or Bill A Heart Catheterization

How do you code and bill a heart catheterization?  And how much does Medicare pay for a heart catheterization?". There are five components.  Anyone reading my blog knows how complicated CPT® coding is.  Please reference the  CPT 2013 Standard Edition as the up to date definitive authority.  The following are the codes that are billed to the Medicare National Bank every time a heart catheterization is performed. Remember, there are fees paid to doctors and fees paid to hospitals. And they are completely separate from each other. These fees will change based on a geographic modifier (what part of the country you live in) but assume normal cost of living cities. 

1)  CPT® 93510: Left heart catheterization, retrograde (sticking the needle in the groin and guiding the catheter to the heart). 

2)  CPT® 93545: Injection procedure during heart catheterization (squirting some dye in the arteries).

3)  CPT® 93543: Left ventricular angiography (squirting dye into the heart's left ventricle). 

4) CPT® 93555: Interpretation and report of injection procedure during cardiac catheterization, ventricular and/or atrial angiography ("What's my ejection fraction doc?"). 

5)  CPT® 93556: Interpretation and report for injection procedure of the arteries ("Are my arteries blocked doc?") .

Start to finish for a heart cath including procedural, documentation and time spent talking with  family  is about one hours time from start to finish for left heart catheterization with left ventriculogram and arteriogram with interpretation and report.

Time spent: 60 minutes

You can learn more about coding here in my CPT® coding lectures.


LINK TO HOSPITALIST E/M  CARD POST


EM Pocket Reference Cards Using Marshfield Clinic Point Audit



Click image for high definition view

Facebook humor:

Happy: Do you have any heart problems?
Patient: Yes. Doc opened 4 of my Coronas.
Happy: That was rude of him.


Print Friendly and PDF

5 Outbursts:

  1. thank you for having this blog.

    ReplyDelete
  2. Another thing I find sad is that the cardiologist is paid more to stick a need in someone's groin than he is for interpreting the results.

    ReplyDelete
  3. Welcome to the irrational lack of cognition in the eyes of the Medicare Bank

    ReplyDelete
  4. HH-
    You’re doing the numbers wrong.
    The 2.61 malpractice RVUs is for 93510 without modifiers, i.e., the total fee for physician and facility.
    93510, when done in a facility (i.e., hospital cath lab) and billed by the cardiologist carries the -26 modifier and has the following RVUs: 4.32 for work, 2.23 Practice expense, and 0.3 for malpractice expense. Add them up and then multiply by the conversion factor ($38.087) to get the fee.
    The 2.61 malpractice RVUs includes the malpractice for the hospital/facility as well. (2.31 for the hospital, 0.3 for the “provider.”). The facility bills for the code with a –TC modifier to tell CMS that it is doing only the technical component. It’s a bit complicated, but then, so is medicine.
    All the data are from www.hhs.cms.gov
    As to your point about procedures paying more than E/M services- that has been true more or less forever. You can complain, but it’s your choice to do “cognitive” medicine. (I put it in quotes because I cognate too- I just don’t make that big a deal of it). When the cardiologist does the same service as you, e.g., a 9921x office visit, he gets the same reimbursement as you do, despite having twice the post-grad training. Is that also unfair? You can stick it to the man by doing a cardiology fellowship- that’ll show ‘em. What, you don’t want to invest the time, opportunity cost, and energy? Your choice. You called it a no-brainer that docs would do a cardiology fellowship instead of stopping training after IM residency. Consider the implications of that statement.
    You can “suggest” that the complication rate for ICU management is higher than for caths, but the malpractice cost factor in the RVU calculation is data-driven. It's not based on complication rates anyway, it's based on malpractice premiums paid by the various specialties. Of course, if you misinterpret the way RVUs and reimbursements are calculated, it’s a GIGO situation.

    ReplyDelete
  5. According to the American Heart Association, heart disease is the nation's single leading cause of death for both men and women. At least 58.8 million people in this country suffer from some form of heart disease.
    And on the whole, cardiovascular diseases (the combination of heart disease and stroke) kill some 950,000 Americans every year.
    Still, there are many misconceptions about heart disease: "The biggest misconception is that heart disease only happens to the elderly," said Elizabeth Schilling, CRNP with the Center for Preventive Cardiology Program at the University of Maryland Medical Center.
    In fact, according to the American Heart Association, almost 150,00 Americans killed by cardiovascular disease each year are under the age of 65. And one out of every 20 people below the age of 40 has heart disease.
    So, it is now a wise decision to keep a constant monitoring of your health. Why to take a chance if we have the option. I was in the similar misconception that heart disease are far away waiting for me to get aged. But to my surprise, I was found to be having a calcium deposit in my coronary arteries. I need to have my advance diagnostic scans due reassure whether something really deadly is waiting for me. Though it was some dreadful going on in my life, but I never felt any kind of discomfort in Elitehealth.com advanced diagnostic facility. They were having some of the latest diagnostic equipments and non invasive techniques which made me feel safe.

    ReplyDelete

By Posting Here I Promise To Do Something Nice For Someone Today