Coding Cardiac Catheterization

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February 3, 2015

What Is Cardiac Catheterization?Cardiac catheterization is a medical procedure used to diagnose and treat some heart conditions. A long, thin, flexible tube called a catheter is put into a blood vessel in the arm, groin, or neck and threaded to the heart. This portion of the catheterization is not the procedure; it is the percutaneous approach to the heart and great vessels.

The physician may put a special type of dye in the catheter. The dye will flow through the bloodstream to the heart. Then, the physician will take images of the heart, usually of the left heart (Left Cardiac Catheterization), but may be of the right heart, or of the left and right heart. This is coded as: • Measurement, Cardiac.

The dye will make the coronary arteries visible on the pictures. This test is coronary angiography. This is coded as: • Fluoroscopy, Artery, Coronary • OR • Plain Radiography, Artery, Coronary

What Is Cardiac Ventriculography?Cardiac Ventriculography is a medical imaging test used to determine a patient's cardiac function most often in the left ventricle, but may be of the right ventricle, or of the left and right ventricle. Cardiac ventriculography involves injecting contrast media into the heart's ventricle(s) to measure the volume of blood pumped. This is coded as: • Fluoroscopy, Heart

ICD-10-PCS Code structure in the Measurement and Monitoring Section:

Measurement and Monitoring Section

The Measurement and Monitoring section is section 4 of ICD-10-PCS and includes codes procedures that determine the level of a physiological or physical function. The first character in the Measurement and Monitoring section is “4.”

ICD-10-PCS Code structure in the Imaging Section:

Imaging Section

“B” is the value that represents the Imaging Section as the first character

Example:

Procedure: Left heart catheterization, coronary angiography and left ventriculogram Description of Procedure: The right groin was prepped and draped in the usual sterile fashion and locally anesthetized. The right femoral artery was entered with 18 gauge needle and J guide wire was introduced into descending aorta. A French left coronary artery catheter was introduced and selective injections using iodixanol were made into the left coronary artery. A right coronary artery catheter was introduced and selective injections using iodixanol were made of right coronary artery. The right coronary artery catheter was exchanged and the left heart catheterization was performed at rest with pressures being measured. The left ventriculogram was performed using iodixanol. Total fluoroscopy time: 7.5 minutes

Example Part 1: Left heart catheterization 4A023N7ICD-10-PCS Index

Catheterization see Dilation see Drainage see Irrigation see Insertion of device in Heart see Measurement, Cardiac 4A02

Character1

Section

Character2

BodySystem

Character3

RootOperation

Character4

BodySystem

Character5

Approach

Character6

Function/Device

Character7

Qualifier

ICD-10-PCS Tabular

Example Part 2: Coronary angiography B2111ZZ“A French left coronary artery catheter was introduced and selective injections using iodixanol were made into the left coronary artery. A right coronary artery catheter was introduced and selective injections using iodixanol were made of right coronary artery.” • First, the coder needs to know is iodixanol a: • High osmolar contrast? • Low osmolar contrast? • Other contrast? • Second, the coder needs to know the number of arteries visualized • Two, left coronary artery and right coronary artery • Third, the coder needs to know the type of imaging done: • Total fluoroscopy time: 7.5 minutes

ICD-10-PCS Index

Fluoroscopy Artery Coronary Multiple B211 Laser, Intraoperative B211 Single B210 Laser, Intraoperative B210

ICD-10-PCS Tabular

Example Part 3: Left ventriculogram using iodixanol B2151ZZICD-10-PCS Index

Fluoroscopy Heart Left B215 Right B214 Right and Left B216

ICD-10-PCS Tabular

Final codes for this procedure:

• Left heart catheterization 4A023N7 • Coronary angiography B2111ZZ • Left ventriculogram using iodixanol B2151ZZNote: The coder must be guided by documentation in the medical record of each individual case to make the correct code selections.

Vol. 5

Character1

Section

Character2

BodySystem

Character3

Root Type

Character4

Body Part

Character5

Contrast

Character6

Qualifer

Character7

Qualifier

SectionBody SystemOperation

Measurement and MonitoringPhysiological SystemsMeasurement: Determining the level of a physiological or physical function at a point in time

4A0

0 Open3 Percutaneous

6 Right Heart7 Left Heart8 Bilateral

N Sampling and Pressure

Body System Approach Funtion/Device Qualifier

2 Cardiac

SectionBody SystemType

ImagingHeartFluoroscopy: Single plane or bi-plane real time display of an image developed from the capture of external ionizing radiation on a fluorescent screen. The image may also be stored by either digital or analog means

B21

0 High Osmolar1 Low OsmolarY Other Constrast

Z NoneZ None

Body Part Contrast Qualifier Qualifier

0 Coronary Artery, Single1 Coronary Artery, Multiple2 Coronary Artery Bypass Graft, Single3 Coronary Artery Bypass Graft, Multiple

SectionBody SystemType

ImagingHeartFluoroscopy: Single plane or bi-plane real time display of an image developed from the capture of external ionizing radiation on a fluorescent screen. The image may also be stored by either digital or analog means

B21

0 High Osmolar1 Low OsmolarY Other Constrast

Z NoneZ None

Body Part Contrast Qualifier Qualifier

4 Heart, Right5 Heart, Left6 Heart, Right and Left7 Internal Mammary Bypass Graft, Right8 Internal Mammary Bypass Graft, LeftF Bypass Graft, Other

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The ICD-10 Fun Corner

Anthelio's ICD-10 Obstetrics MatchCode Game

Directions: Match the correct ICD-10-CM code next to the following:

© 2015 Anthelio Healthcare Solutions Inc. Proprietary and confidential. All Rights Reserved. www.antheliohealth.com

Z37.61Intrauterine pregnancy, 12 weeks gestation, undelivered, with mild hyperemesis gravidarum

O86.12Therapeutic abortion, complete, with embolism

O90.3Elective sterilization

Z30.2Gestational hypertension pregnancy, third trimester, undelivered

O13.3Endometritis following delivery

O04.7Outcome of delivery, triplets, one stillborn

O21.0Peripartum cardiomyopathy

The answers are on the next page.

The ICD-10 Fun Corner

Anthelio's ICD-10 Obstetrics MatchCode Game Solution

© 2015 Anthelio Healthcare Solutions Inc. Proprietary and confidential. All Rights Reserved. www.antheliohealth.com

Z37.61

Intrauterine pregnancy, 12 weeks gestation, undelivered, with mild hyperemesis gravidarum

O86.12

Therapeutic abortion, complete, with embolism

O90.3

Elective sterilization Z30.2

Gestational hypertension pregnancy, third trimester, undelivered O13.3

Endometritis following delivery

O04.7

Outcome of delivery, triplets, one stillborn

O21.0

Peripartum cardiomyopathy