Coding Tip: Cardiac Catheterization Coding in ICD-10-PCS
Kim Carrier RHIT, CDIP, CCS, CCS-P
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer
Changes in Cardiac Catheterization Code Descriptions and Reporting
With the implementation of ICD-10-PCS the description of codes became much more detailed to describe exactly what is being performed. Cardiac catheterization is one of the descriptions that changed to further detail exactly what is being performed during the procedure.
In ICD-9, the description of the codes reported for the heart catheterizations were: 37.22-Left heart catheterization; 37.21-Right heart catheterization; and 37.23-Combined right & left heart cardiac catheterization. This was difficult to code because physicians were documenting that they were performing a left and/or right cardiac catheterization, without full understanding of what is needed to report these procedures.
- 4A023N7—Measurement of cardiac sampling and pressure, left heart, percutaneous approach
- 4A023N6—Measurement of cardiac sampling and pressure, right heart, percutaneous approach
- 4A023N8—Measurement of cardiac sampling and pressure, bilateral, percutaneous approach
ICD-10-PCS has taken away the misunderstandings that were being seen, by changing the description of the ICD-10-PCS codes to truly fit the procedure that is being performed. The description now states that a measurement is taken.
As you can see, all of these now require measurement in order to be reported.
Photo courtesy Wikimedia
Note: There are also multiple definitive procedures that may be performed during a cardiac catheterization but this coding tidbit is focusing on the diagnostic aspects.
What is a Cardiac Catheterization?
A cardiac catheterization is a procedure performed to diagnose or treat certain cardiovascular conditions. Small catheters are inserted into blood vessels to obtain x-ray pictures of the coronary arteries and cardiac chambers. The catheters are put into a blood vessel in your arm, neck or groin/upper thigh. The entry site of the catheter does not impact the ICD-10-PCS code. During cardiac catheterization, pressures may be measured for intra-cardiac hemodynamics which show the blood flow in the heart or even take samples of blood or biopsy of heart muscle.
Diagnostic Left Heart Catheterization includes: the left atrium, ventricle, the mitral and aortic valves, the ascending left aorta and possible the pulmonary veins.
Diagnostic Right Heart Catheterization includes: the right atrium, ventricle, tricuspid and pulmonary valves, the main pulmonary branches and superior and inferior vena cava.
Diagnostic Combined Heart Catheterization includes: a single procedure which includes the evaluation of both the left and right as above.
Common Diagnostic Procedures Performed During Cardiac Catheterization
- Coronary angiography—oftentimes performed during a diagnostic cardiac catheterization to check for blockages in the arteries of the heart. Dye is injected through the catheter and special x-ray images are taken of the heart as the dye moves through the heart chambers, valves and major vessels. The type of contrast used for the angiography must be known in order to accurately report the appropriate ICD-10-PCS code. This procedure may be completed with or without a diagnostic heart catheterization. The reason for this is that the coronary arteries branch off of the aorta just before the heart and aortic valve. In order to report a diagnostic left heart catheterization, the aortic valve must be crossed with the catheter and LV pressures for hemodynamics obtained.
- Ventriculogram—performed to evaluate ventricle contraction and blood flow in the heart. This test is performed to diagnose or assess heart valve issues and is also a test that measures the ejection fraction of the heart. Contrast is injected into the heart’s ventricle(s) to measure the volume of blood being pumped. If a ventriculogram is performed during a left heart catheterization, the catheter is moved through the aortic valve into the left side of the heart. If a ventriculogram is performed during a right heart catheterization, the catheter is moved into the right side of the heart in order to record pressures from the right atrium and right ventricle.
- Intravascular ultrasound (IVUS)—performed via an ultrasound catheter with ultrasound capabilities to record pictures of vessels evaluated. This allows the physician to see and measure the inside of the blood vessels.
- Fractional flow reserve (FFR)—guidewire based procedure that can accurately measure blood pressure and flow through a specific part of the coronary artery. This test helps the physician determine if a vessel is amenable to angioplasty or stenting.
Coding Tips for Reporting Left and Right Heart Catheterizations
- Know the common abbreviations used during cardiac procedures
- Look for pressures in the procedure note: LV pressures (mm/hg) should be documented when a left heart catheterization is performed; RV pressures should be documented when a right heart catheterization is performed. Remember that pressures must be documented in order to report in ICD-10-PCS.
- If the pressures are not in the procedure note, coders oftentimes find them in the procedure event log or “run sheet” and it is appropriate to look here
- In order to report a left heart catheterization, the catheter must cross the aortic valve
- Coronary angiography may be completed without a true left heart catheterization because the coronary arteries branch off of the aorta just before the aortic valve
References
heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/cardiac-catheterization
mayoclinic.org/tests-procedures/cardiac-catheterization/about/pac-20384695
hopkinsmedicine.org/health/treatment-tests-and-therapies/cardiac-catheterization
clevelandclinic.org/health/diagnostics/16832-cardiac-catheterization/test-details
http://commons.wikimedia.org/wiki/Heart
For more information on coding cardiac catheterizations and associated diagnostic and definitive procedures, please check out our action plan on this subject.
Happy Coding!
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
Popular Posts
Telehealth and the Coronavirus
The US government and public-health officials are urging consumers to utilize telemedicine for remote treatment, fill prescriptions and get medical attention during the new coronavirus pandemic. The goal is to keep people with symptoms at home and to practice social distancing if their condition doesn’t warrant more intensive hospital care.
Coronavirus: Tips for Working from Home
Coronavirus: Tips for working from home. Companies around the world have told their employees to stay home and work remotely. Whether you’re a new to this concept or a work from home veteran, here’s some tips to staying productive from our #HIAfamily.
Part 3: Coder and CDI Communication Example | CDI Series
This is the final part of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we provide an actual example of an effective communication response to CDI.
Part 2: How Coders Can Address Coding Mismatches | CDI Series
This is part two of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we discuss mismatches and how to best go about resolving them. In part three we will provide a case example of best practice interaction.
Part 1: How Coders Can Better Interact with CDI Teams | CDI Series
This is part one of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. Many times these departments are separate and the remote environment makes it difficult to interact efficiently between the two departments. In part one, we will discuss the history and objectives of CDI so the coder has a better understanding of CDI’s role.
Subscribe to our weekly newsletter
Latest News
Telehealth and the Coronavirus
The US government and public-health officials are urging consumers to utilize telemedicine for remote treatment, fill prescriptions and get medical attention during the new coronavirus pandemic. The goal is to keep people with symptoms at home and to practice social distancing if their condition doesn’t warrant more intensive hospital care.
Coronavirus: Tips for Working from Home
Coronavirus: Tips for working from home. Companies around the world have told their employees to stay home and work remotely. Whether you’re a new to this concept or a work from home veteran, here’s some tips to staying productive from our #HIAfamily.
Part 3: Coder and CDI Communication Example | CDI Series
This is the final part of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we provide an actual example of an effective communication response to CDI.
Part 2: How Coders Can Address Coding Mismatches | CDI Series
This is part two of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we discuss mismatches and how to best go about resolving them. In part three we will provide a case example of best practice interaction.
Part 1: How Coders Can Better Interact with CDI Teams | CDI Series
This is part one of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. Many times these departments are separate and the remote environment makes it difficult to interact efficiently between the two departments. In part one, we will discuss the history and objectives of CDI so the coder has a better understanding of CDI’s role.
Coding Tip: Coding Diagnoses on Outpatient Encounters
One reason that coders should report chronic conditions (including history and status codes) on outpatient records is the HCC’s—Hierarchical Condition Categories. The quick and easy explanation of what HCC’s are is each HCC is mapped to certain ICD-10-CM codes or code ranges. HCC coding is designed to estimate future health care costs for patients.
Part 5: Top 5 ICD-10-CM Chapters 2019 | Acute Care Reviews
For Part 5 of this 5-part series, we will look at Chapter 4 within ICD-10-CM—E00-E89—Endocrine, Nutritional, and Metabolic Diseases. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
Part 4: Top 5 ICD-10-CM Chapters 2019 | Acute Care Reviews
For Part 4 of this 5-part series, we will look at Chapter 10 within ICD-10-CM—J00-J99—Diseases of the Respiratory System. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
Part 3: Top 5 ICD-10-CM Chapters 2019 | Acute Care Reviews
For Part 3 of this 5 part series, we will look at Chapter 9 within ICD-10-CM—I00-I99—Diseases of the Circulatory System. This chapter contains so many of the everyday diagnoses that we code such as hypertension, heart disease and stroke.
Part 2: Top 5 ICD-10-CM Chapters 2019 | Acute Care Reviews
For Part 2 of this 5-part series, we will look at Chapter 1 within ICD-10-CM—A00-B99—Certain Infectious and Parasitic Diseases. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
Part 1: Top 5 ICD-10-CM Chapters 2019 | Acute Care Reviews
For Part 1 of this 5-part series, we will look at Chapter 21 within ICD-10-CM—Z00-Z99—Factors influencing health status and contact with health services. There is no possible way to include every guideline or coding reference for this chapter, but I’ll do my best to touch on some off the most common issues.
Coding & Quality Measures Tip: Social Determinants of Health
The HIM world has been buzzing recently with discussion of “Social Determinants of Health” and coded data. What does this mean for coders and the HIM field?
New ICD-10-CM Code for Vaping-Related Disorder
In response to the recent occurrences of vaping related disorders and in consultation with the World Health Organization (WHO) Framework Convention on Tobacco Control, the WHO Family of International Classifications (WHOFIC) Network Classification and Statistics Advisory Committee (CSAC) was convened to discuss a diagnosis code for vaping related illness for immediate use.
CDC Develops ICD-10 Code for 2019 Novel Coronavirus (COVID-19)
The Centers for Disease Control and Prevention (CDC) is in process of developing a new code for the COVID-19 (coronavirus) that will be released October 1, 2020. In the meantime, the CDC has provided advice on coding the COVID-19 coronavirus.
Most Common DRG’s with Recommendations 2019: #1
We’re finally at the #1 most common DRG with recommendations by HIA for 2019. Just to recap, HIA reviewed over 50,000 inpatient records in 2019. Most have probably already guessed what the correct DRG would be with the most recommendations. There are just some diagnoses and DRG’s that will always be a thorn in the side for coders. #1 DRG with the most recommendations during HIA reviews : DRG 871—Septicemia or severe sepsis w/o mechanical ventilation >96 hours with MCC
Most Common DRG’s with Recommendations 2019: #2
We’re now at the second most common DRG with recommendations by HIA for 2019. Just to recap, HIA reviewed over 50,000 inpatient records in 2019. We are counting down to # 1. #2 DRG with the most recommendations during HIA reviews: DRG 872—Septicemia or severe sepsis w/o mechanical ventilation >96 hours w/o MCC.
Most Common DRG’s with Recommendations 2019: #3
In 2019, HIA reviewed over 50,000 inpatient records. Wow! That is a lot of records. Even with this large number of records, the DRG’s with recommendations are still the ones that coders typically see during audits. #3 DRG 190—Chronic obstructive pulmonary disease with MCC.
Most Common DRG’s with Recommendations 2019: #4
In 2019, HIA reviewed over 50,000 inpatient records. Wow! That is a lot of records. Even with this large number of records, the DRG’s with recommendations are still the ones that coders typically see during audits. #4 is DRG 193—Simple pneumonia & pleurisy with MCC.
Most Common DRG’s with Recommendations 2019: #5
In 2019, HIA reviewed over 50,000 inpatient records. Wow! That is a lot of records. Even with this large number of records, the DRG’s with recommendations are still the ones that coders typically see during audits. #5 DRG with the most recommendations during HIA reviews : DRG 853—Infectious & Parasitic diseases with O.R. procedure with MCC
A Decade in Review: Pivotal HIM Moments
Pivotal moments in the Health Information Management field include the implementation of ICD-10, CPT Coding Changes, Acute care changes, profee changes, recovery audit contractor implementation, new ransomware challenges, Meaningful use and much more.
Part 3: Top 3 CM Chapters 2019 from ProFee Reviews
In 2019, we reviewed over 50,000 diagnosis codes from many different specialties for our Professional Fee clients. For the final part of this 3-part series, we will look at R00-R99 – Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified.
Part 2: Top 3 CM Chapters 2019 from ProFee Reviews
The Circulatory chapter is one that is identified every year as having a large number of coding changes. Many of these changes are related to documentation providing more specificity and, in some cases, less specificity than the codes reported. Below we will discuss some of the areas of opportunity in this chapter.
Part 1: Top 3 CM Chapters 2019 from ProFee Reviews
In 2019, we reviewed over 50,000 diagnosis codes from many different specialties for our Professional Fee clients. Here are the top three ICD-10-CM chapters where HIA identified coding opportunities: Z00-Z99 – Factors influencing health status and contact with health services; I00-I99 – Circulatory system and; R00-R99 – Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified.
Part 4: New 2020 CPT Codes | Digestive, Urinary, Nervous, Ocular and Auditory Systems
This is Part 4 of a five part series on the new 2020 CPT codes. In this series we will explore the CPT changes for FY 2020 and include examples to help the coder understand the new codes. There is 3 new digestive system codes with 1 deletion and 2 revised; 1 revised urinary system codes with new category III codes; 6 new with 20 deleted nervous system codes with 3 revisions; 2 new eye codes with 3 revisions; and finally a new category III auditory code.
Part 3: New 2020 CPT Codes | Cardiovascular System
This is Part 3 of a five part series on the new 2020 CPT codes. In this series we will explore the CPT changes for FY2019 and include examples to help the coder understand the new codes. There are 11 new cardiovascular CPT codes added with 8 deletions and 2 revisions.
Part 2: New 2020 CPT Codes | Musculoskeletal System
This is Part 2 of a five part series on the new 2020 CPT codes. In this series we will explore the CPT changes for FY2020 and include some examples to help the coder understand the new codes. There are 11 new musculoskeletal CPT codes added with 1 deletion and 0 revisions.
Part 1: New 2020 CPT Codes | Integumentary System
This is Part 1 of a five part series on the new 2020 CPT codes. In this series we will explore the CPT changes for FY2020 and include examples to help the coder understand the new codes. For 2020 in general, there were 248 new CPT codes added, 71 deleted and 75 revised.
Part 6: CPT Breast Education Series | Revision of Breast Reconstruction
This is Part 6 of a 6-part series focusing on CPT coding of breast procedures. There are many different types of breast reconstruction procedures, each having potential stumbling-blocks for coders. Part 6 focuses on revision of a reconstructed breast.
Part 5: CPT Breast Education Series | Breast Reconstruction Using Autologous Tissue Flaps
This is Part 5 of a 6-part series focusing on CPT coding of breast procedures. There are many different types of breast procedures, each having potential stumbling-blocks for coders. This series will address several of the more confusing topics. Part 5 focuses on the coding of different types of autologous tissue breast reconstruction procedures.