Right Heart Catheterization and Endomyocardial Biopsy

Good morning! I have a question in regards to Cardiac Cath procedures. When exactly would it be appropriate to bill CPT code 93501 with CPT code 93505? I am not sure that I am completely understanding the regulations on this particular service. I know a modifier is allowed, but I don't want to do that unless I know that is it appropriate for that given service based on the documentation. Any help would be appreciated! Thank you!

Michelle Yaden, CPC, CEMC, CPC-I

93505

If a endomyocardial biopsy is performed at the time of a diagnostic cardiac catheterization, then both should be billed with medical necessity documentation. The 59 modifier is placed on code 93501. However, if the heart cath is performed only to obtain the biopsy, only code 93505 should be billed.

Right Heart Catheterization and Enodmyocardial Biopsy

Nancy,
Thank you for your reply. I have one in front of me that after reading it again, it seems that the catheterization was done for the biopsy, therefore, only the biopsy should be reported. Here is basically what the report says.

The jugular vein was cannulated percutaneously with a 5F sheath, 50 cm Ceres biopsy forceps was introduced from the sheath into the rt. ventricle and angled toward the ventricular septum. 5 right endomyocardial biopsies were obtained. The biotome was replaced with a wedge catheter and blood samples were taken and sent for studies. The wedge catheter was then advanced prograde into the rt pulmonary artery by way of rt atrium, rt ventricle and main pulmonary artery. Pressures were recorded. Several chambers were entered. Catheter and sheath were withdrawn, hemostasis achieved.

Am I thinking right in the fact that the biopsy (93505) should only be reported and not both codes (93501 and 93505). Just want to make sure. Thanks for helping! This is not my area of expertise.

Michelle

right Heart Catheterization

This procedure involves insertion of a catheter into the venous system. The catheter is advanced into the right atrium, right ventricle, pulmonary artery, and pulmonary capillary wedge positions, where pressure measurements are taken and imaging may be performed The right heart catheterization is a diagnostic procedure and must show medical necessity, signs/symptoms, CHF, pulmonary hypertension, congenital anomalies, etc. Also: Patients with known or suspected valvular heart disease ; Patients with known or suspected intracardiac shunt (i.e., ASD, VSD); Patients with previous myocardial infarction; Patients with unexplained symptoms (i.e., shortness of breath), suspected to have cardiac origin ; Patients in whom pulmonary artery disease is known or suspected (i.e., pulmonary hypertension, status post pulmonary emboli) .

The endomyocardial biopsy is performed to diagnose cardiomyopathy or myocarditis as examples.
Look to what was the reason for the biopsy and then, what was the reason for the right heart cath.

93505 and 93451 coding and billing

[If a endomyocardial biopsy 93505 is performed at the time of a diagnostic cardiac catheterization 93451 on a Heart transplant patient to measure hemodynamics due to the denervation of the heart and the potential that usual signs and symptoms would be absent shoudl we bill for both and use Modifier -59? I can find all kinds of documentation but it is inconsistent. Can you help and provide a reference if possible?