Cardiology

Cardiology Question for the Week of April 27, 2020

Cardiology Compliance Question of the Week

Question:

A diagnostic cardiac catheterization is performed demonstrating two-vessel coronary disease. Due to the contrast load, the procedure is staged. A lesion in the LAD is treated by a DES at the initial session and the right coronary lesion is treated at a separate encounter. Can the injection of the coronary arteries during the second encounter be coded and billed with code 93454 (coronary angiography only)?

Answer:

Medical necessity is required to code and bill another diagnostic study. For example, a prior study is available but is documented in the medical record as follows: The patient’s condition with respect to the clinical indication has changed since the prior study. A staged intervention where coronary injections are done prior to the procedure, to set up the procedure, is not billable.


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