Cardiac Catheterization and Coronary Angiography (L30719)
Contractor Information
|
Contractor Name Wisconsin Physicians Service Insurance Corporation |
Contractor Number 00951, 00952, 00953, 00954, 52280, 05101, 05201, 05301, 05401, 05102, 05202, 05302, 05402 |
Contractor Type Carrier - FI - MAC |
LCD Information
Document Information
L30719 LCD Title Cardiac Catheterization and Coronary Angiography Contractor's Determination Number CV-006 AMA CPT/ADA CDT Copyright Statement CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. |
Primary Geographic Jurisdiction
Oversight Region Original Determination Effective Date For services performed on or after 07/16/2010 Original Determination Ending Date Revision Effective Date For services performed on or after 10/01/2011 Revision Ending Date |
CMS National Coverage Policy
Title
XVIII of the Social Security Act, section 1833 (e) prohibits Medicare
Payment for any claim which lacks the necessary information to process
the claim.
Title XVIII of the Social Security Act, section 1862 (a)(1)(A) excludes Medicare coverage for "items or services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member."
IOM 100-04 Chapter 12; 100.1.5 - Other Complex or High-Risk Procedures
Title XVIII of the Social Security Act, section 1862 (a)(1)(A) excludes Medicare coverage for "items or services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member."
IOM 100-04 Chapter 12; 100.1.5 - Other Complex or High-Risk Procedures
Indications and Limitations of Coverage and/or Medical Necessity
Cardiac
catheterization/coronary angiography is considered the standard for
evaluating ventricular function, assessing valvular heart disease and
coronary artery anatomy for patient management. While other methods are
available, and are important in the overall evaluation, cardiac
catheterization combined with coronary angiography is typically
considered the key in clinical decision-making in the surgical or
percutaneous candidates. The anatomic definition provided with cardiac
catheterization and coronary angiography may include assessment of the
right and left heart function, valvular function, congenital heart
disease, coronary anatomy, status of bypass graft, presence, extent, and
severity of obstructive atherosclerotic coronary disease, coronary
artery size, coronary collateral flow, thrombus formation, dynamic
obstructions (coronary spasm), congenital coronary artery anomalies,
and/or other anomalies (e.g., dissection due to trauma, aneurysmal
dilation due to Kawasaki disease).
Cardiac catheterization and coronary angiography are performed for diagnostic purposes, to assess the appropriateness and feasibility of various forms of cardiac therapy including medical therapy, interventional therapy, and particularly cardiac surgery. Coronary angiography is aimed directly at assessing the coronary arteries for treatment (e.g., PTCA, CABG, thrombolysis, and medical management), assessing the results of therapy, and determining the prognosis in patients with coronary artery disease.
A cardiac catheterization procedure typically includes insertion of a catheter through a vessel by cutdown or percutaneous technique (e.g., femoral, brachial, axillary, radial artery, left ventricular puncture) with local anesthesia and appropriate sedation. The catheter is advanced through the circulatory system into the heart under fluoroscopic guidance. Hemodynamic measurements to assess ventricular function, and/or valvular function, blood samples, injections of contrast, or endomyocardial biopsy may be performed during the procedure. Coronary arteries are visualized directly with selective angiography by injecting contrast material. Multiple catheter types may be inserted for specific procedures.
A. Covered indications for left cardiac catheterization/coronary angiography include the following:
1. Patients without symptoms or with atypical symptoms, who have had documented evidence of CAD on specified noninvasive cardiac testing:
a. Rest or exercise-induced electrocardiography (ECG) abnormalities suggesting
myocardial ischemia associated with other risk factors. Abnormal exercise ECG including ST segment depression, exercise-induced ST elevation in leads other than aVr, blunted systolic blood pressure response during progressive exercise, or exercise-induced ventricular tachycardia.
b. Abnormal myocardial perfusion scintigraphy includes radiopharmaceutical distribution that is compatible with coronary ischemia: decreased distribution in one or more vascular regions at rest or with exercise, evidence of transient ischemic dilation, or abnormal distribution associated with increased lung uptake produced by exercise in the absence of severely depressed left ventricular function at rest.
c. Abnormal radionuclide ventriculography where the left ventricular ejection fraction falls during exercise or rest, and the findings are suggestive of CAD.
d. Abnormal echocardiographic global or regional left ventricular function at rest or in response to pharmacologic or exercise stress testing.
2. After successful resuscitation from cardiac arrest when a reasonable suspicion of coronary artery disease exists.
3. Prior to a high risk surgery, which includes major emergency surgery, aortic and other major vascular surgery, peripheral vascular surgery, and anticipated prolonged procedures associated with large fluid shifts and/or blood loss.
4. Angina that has proven inadequately responsive to medical treatment or prior intervention (e.g., PTCA, thrombolytic therapy, CABG).
5. Acute Coronary Syndrome including unstable angina, non-ST elevation MI and ST elevation MI.
6. Angina associated with abnormal results of non-invasive cardiac testing that are suggestive of CAD.
7. When the presence of atypical chest pain due to coronary spasm is suspected, or there are signs and symptoms of abnormal left ventricular function.
8. Complicated myocardial infarction, when one of the following exist:
a. The patient experiences an episode(s) of ischemic chest pain, particularly when accompanied with ECG changes.
b. Mitral regurgitation or ruptured interventricular septum is suspected, particularly when accompanied with heart failure or shock.
c. Sub acute cardiac rupture (pseudo aneurysm) is suspected.
d. Hemodynamic compromise or clinical heart failure exists.
e After non-Q-wave myocardial infarction, particularly when there is suspicion of ischemia post-MI.
f. Recurrent, potentially malignant ventricular arrhythmias.
g. Evidence of myocardial ischemia (e.g., abnormal blood pressure response or ventricular tachycardia on pre-discharge exercise stress testing, abnormal laboratory testing or non-invasive cardiac tests).
h. Heart failure or left ventricular ejection fraction is significantly decreased and is associated with manifestations of recurrent myocardial ischemia, or is associated with significant ventricular arrhythmias.
i. Evaluation for multivessel disease for prognosis and management.
9. When valve surgery is being considered, or other listed valvular pathology exists in an adult patient with chest discomfort or ECG changes, and the patient is at risk for CAD.
10. When corrective open heart surgery for congenital heart disease is being planned, and the patient is at risk for CAD.
11. Evaluation of patients with congenital heart disease who have signs or symptoms suggesting associated CAD.
12. Suspected congenital coronary anomalies (such as congenital coronary artery stenosis, coronary arteriovenous fistula, anomalous origin of left coronary artery) provided that aortography is not diagnostic.
13. In diseases affecting the aorta when knowledge of the presence or extent of coronary artery involvement is necessary for management.
14. The presence of left ventricular failure without obvious cause.
15. Patients with hypertrophic cardiomyopathy who are being evaluated for therapy of outflow tract obstruction.
16. The presence of, or suspicion of, heart neoplasms.
17. Post-cardiac transplant, to assess for rejection and/or coronary artery disease.
18. Hemodynamic evaluation of pulmonary hypertension
B. Covered indications for right heart catheterization, or combined right and left heart catheterization procedures include the following:
1. In situations in which right ventricular function may be abnormal (right ventricular infarction, tricuspid regurgitation, ventricular septal defect).
2. Where pulmonary artery disease is suspected (e.g., pulmonary hypertension, pulmonary emboli, pulmonary vascular abnormalities).
3. Where unexplained congestive heart failure is present, or right heart failure due to pulmonary hypertension or pulmonary interstitial disease.
4. Where intracardiac shunt is suspected (e.g., atrial septal defect), ventricular septal defect, papillary muscle rupture, or pseudo aneurysm complicating an acute myocardial infarction.
5. Abnormal findings from cardiac testing (e.g., echocardiogram) indicating right heart disease.
6. Cardiomyopathy.
7. Clinically suspected or known valvular heart disease.
8. Post-cardiac transplant, to assess ventricular function and/or rejection.
9. Known or suspected significant pericardial disease, myocarditis, or endocarditis.
10. Congenital heart disease affecting the right heart.
Cardiac catheterization and coronary angiography are performed for diagnostic purposes, to assess the appropriateness and feasibility of various forms of cardiac therapy including medical therapy, interventional therapy, and particularly cardiac surgery. Coronary angiography is aimed directly at assessing the coronary arteries for treatment (e.g., PTCA, CABG, thrombolysis, and medical management), assessing the results of therapy, and determining the prognosis in patients with coronary artery disease.
A cardiac catheterization procedure typically includes insertion of a catheter through a vessel by cutdown or percutaneous technique (e.g., femoral, brachial, axillary, radial artery, left ventricular puncture) with local anesthesia and appropriate sedation. The catheter is advanced through the circulatory system into the heart under fluoroscopic guidance. Hemodynamic measurements to assess ventricular function, and/or valvular function, blood samples, injections of contrast, or endomyocardial biopsy may be performed during the procedure. Coronary arteries are visualized directly with selective angiography by injecting contrast material. Multiple catheter types may be inserted for specific procedures.
A. Covered indications for left cardiac catheterization/coronary angiography include the following:
1. Patients without symptoms or with atypical symptoms, who have had documented evidence of CAD on specified noninvasive cardiac testing:
a. Rest or exercise-induced electrocardiography (ECG) abnormalities suggesting
myocardial ischemia associated with other risk factors. Abnormal exercise ECG including ST segment depression, exercise-induced ST elevation in leads other than aVr, blunted systolic blood pressure response during progressive exercise, or exercise-induced ventricular tachycardia.
b. Abnormal myocardial perfusion scintigraphy includes radiopharmaceutical distribution that is compatible with coronary ischemia: decreased distribution in one or more vascular regions at rest or with exercise, evidence of transient ischemic dilation, or abnormal distribution associated with increased lung uptake produced by exercise in the absence of severely depressed left ventricular function at rest.
c. Abnormal radionuclide ventriculography where the left ventricular ejection fraction falls during exercise or rest, and the findings are suggestive of CAD.
d. Abnormal echocardiographic global or regional left ventricular function at rest or in response to pharmacologic or exercise stress testing.
2. After successful resuscitation from cardiac arrest when a reasonable suspicion of coronary artery disease exists.
3. Prior to a high risk surgery, which includes major emergency surgery, aortic and other major vascular surgery, peripheral vascular surgery, and anticipated prolonged procedures associated with large fluid shifts and/or blood loss.
4. Angina that has proven inadequately responsive to medical treatment or prior intervention (e.g., PTCA, thrombolytic therapy, CABG).
5. Acute Coronary Syndrome including unstable angina, non-ST elevation MI and ST elevation MI.
6. Angina associated with abnormal results of non-invasive cardiac testing that are suggestive of CAD.
7. When the presence of atypical chest pain due to coronary spasm is suspected, or there are signs and symptoms of abnormal left ventricular function.
8. Complicated myocardial infarction, when one of the following exist:
a. The patient experiences an episode(s) of ischemic chest pain, particularly when accompanied with ECG changes.
b. Mitral regurgitation or ruptured interventricular septum is suspected, particularly when accompanied with heart failure or shock.
c. Sub acute cardiac rupture (pseudo aneurysm) is suspected.
d. Hemodynamic compromise or clinical heart failure exists.
e After non-Q-wave myocardial infarction, particularly when there is suspicion of ischemia post-MI.
f. Recurrent, potentially malignant ventricular arrhythmias.
g. Evidence of myocardial ischemia (e.g., abnormal blood pressure response or ventricular tachycardia on pre-discharge exercise stress testing, abnormal laboratory testing or non-invasive cardiac tests).
h. Heart failure or left ventricular ejection fraction is significantly decreased and is associated with manifestations of recurrent myocardial ischemia, or is associated with significant ventricular arrhythmias.
i. Evaluation for multivessel disease for prognosis and management.
9. When valve surgery is being considered, or other listed valvular pathology exists in an adult patient with chest discomfort or ECG changes, and the patient is at risk for CAD.
10. When corrective open heart surgery for congenital heart disease is being planned, and the patient is at risk for CAD.
11. Evaluation of patients with congenital heart disease who have signs or symptoms suggesting associated CAD.
12. Suspected congenital coronary anomalies (such as congenital coronary artery stenosis, coronary arteriovenous fistula, anomalous origin of left coronary artery) provided that aortography is not diagnostic.
13. In diseases affecting the aorta when knowledge of the presence or extent of coronary artery involvement is necessary for management.
14. The presence of left ventricular failure without obvious cause.
15. Patients with hypertrophic cardiomyopathy who are being evaluated for therapy of outflow tract obstruction.
16. The presence of, or suspicion of, heart neoplasms.
17. Post-cardiac transplant, to assess for rejection and/or coronary artery disease.
18. Hemodynamic evaluation of pulmonary hypertension
B. Covered indications for right heart catheterization, or combined right and left heart catheterization procedures include the following:
1. In situations in which right ventricular function may be abnormal (right ventricular infarction, tricuspid regurgitation, ventricular septal defect).
2. Where pulmonary artery disease is suspected (e.g., pulmonary hypertension, pulmonary emboli, pulmonary vascular abnormalities).
3. Where unexplained congestive heart failure is present, or right heart failure due to pulmonary hypertension or pulmonary interstitial disease.
4. Where intracardiac shunt is suspected (e.g., atrial septal defect), ventricular septal defect, papillary muscle rupture, or pseudo aneurysm complicating an acute myocardial infarction.
5. Abnormal findings from cardiac testing (e.g., echocardiogram) indicating right heart disease.
6. Cardiomyopathy.
7. Clinically suspected or known valvular heart disease.
8. Post-cardiac transplant, to assess ventricular function and/or rejection.
9. Known or suspected significant pericardial disease, myocarditis, or endocarditis.
10. Congenital heart disease affecting the right heart.
Coding Information
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
Revenue Codes:
CPT/HCPCS Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
| 0321 | Radiology - Diagnostic - Angiocardiology |
| 0323 | Radiology - Diagnostic - Arteriography |
| 0360 | Operating Room Services - General Classification |
| 0369 | Operating Room Services - Other OR Services |
| 0480 | Cardiology - General Classification |
| 0481 | Cardiology - Cardiac Cath Lab |
| 0519 | Clinic - Other Clinic |
| 052X | Free-Standing Clinic - General Classification |
| 33967 | INSERTION OF INTRA-AORTIC BALLOON ASSIST DEVICE, PERCUTANEOUS |
| 93451 | RIGHT HEART CATHETERIZATION INCLUDING MEASUREMENT(S) OF OXYGEN SATURATION AND CARDIAC OUTPUT, WHEN PERFORMED |
| 93452 | LEFT HEART CATHETERIZATION INCLUDING INTRAPROCEDURAL INJECTION(S) FOR LEFT VENTRICULOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION, WHEN PERFORMED |
| 93453 | COMBINED RIGHT AND LEFT HEART CATHETERIZATION INCLUDING INTRAPROCEDURAL INJECTION(S) FOR LEFT VENTRICULOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION, WHEN PERFORMED |
| 93454 | CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR CORONARY ANGIOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION; |
| 93455 | CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR CORONARY ANGIOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION; WITH CATHETER PLACEMENT(S) IN BYPASS GRAFT(S) (INTERNAL MAMMARY, FREE ARTERIAL VENOUS GRAFTS) INCLUDING INTRAPROCEDURAL INJECTION(S) FOR BYPASS GRAFT ANGIOGRAPHY |
| 93456 | CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR CORONARY ANGIOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION; WITH RIGHT HEART CATHETERIZATION |
| 93457 | CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR CORONARY ANGIOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION; WITH CATHETER PLACEMENT(S) IN BYPASS GRAFT(S) (INTERNAL MAMMARY, FREE ARTERIAL, VENOUS GRAFTS) INCLUDING INTRAPROCEDURAL INJECTION(S) FOR BYPASS GRAFT ANGIOGRAPHY AND RIGHT HEART CATHETERIZATION |
| 93458 | CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR CORONARY ANGIOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION; WITH LEFT HEART CATHETERIZATION INCLUDING INTRAPROCEDURAL INJECTION(S) FOR LEFT VENTRICULOGRAPHY, WHEN PERFORMED |
| 93459 | CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR CORONARY ANGIOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION; WITH LEFT HEART CATHETERIZATION INCLUDING INTRAPROCEDURAL INJECTION(S) FOR LEFT VENTRICULOGRAPHY, WHEN PERFORMED, CATHETER PLACEMENT(S) IN BYPASS GRAFT(S) (INTERNAL MAMMARY, FREE ARTERIAL, VENOUS GRAFTS) WITH BYPASS GRAFT ANGIOGRAPHY |
| 93460 | CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR CORONARY ANGIOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION; WITH RIGHT AND LEFT HEART CATHETERIZATION INCLUDING INTRAPROCEDURAL INJECTION(S) FOR LEFT VENTRICULOGRAPHY, WHEN PERFORMED |
| 93461 | CATHETER PLACEMENT IN CORONARY ARTERY(S) FOR CORONARY ANGIOGRAPHY, INCLUDING INTRAPROCEDURAL INJECTION(S) FOR CORONARY ANGIOGRAPHY, IMAGING SUPERVISION AND INTERPRETATION; WITH RIGHT AND LEFT HEART CATHETERIZATION INCLUDING INTRAPROCEDURAL INJECTION(S) FOR LEFT VENTRICULOGRAPHY, WHEN PERFORMED, CATHETER PLACEMENT(S) IN BYPASS GRAFT(S) (INTERNAL MAMMARY, FREE ARTERIAL, VENOUS GRAFTS) WITH BYPASS GRAFT ANGIOGRAPHY |
| 93462 | LEFT HEART CATHETERIZATION BY TRANSSEPTAL PUNCTURE THROUGH INTACT SEPTUM OR BY TRANSAPICAL PUNCTURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 93463 | PHARMACOLOGIC AGENT ADMINISTRATION (EG, INHALED NITRIC OXIDE, INTRAVENOUS INFUSION OF NITROPRUSSIDE, DOBUTAMINE, MILRINONE, OR OTHER AGENT) INCLUDING ASSESSING HEMODYNAMIC MEASUREMENTS BEFORE, DURING, AFTER AND REPEAT PHARMACOLOGIC AGENT ADMINISTRATION, WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 93503 | INSERTION AND PLACEMENT OF FLOW DIRECTED CATHETER (EG, SWAN-GANZ) FOR MONITORING PURPOSES |
| 93505 | ENDOMYOCARDIAL BIOPSY |
| 93530 | RIGHT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES |
| 93531 | COMBINED RIGHT HEART CATHETERIZATION AND RETROGRADE LEFT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES |
| 93532 | COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT HEART CATHETERIZATION THROUGH INTACT SEPTUM WITH OR WITHOUT RETROGRADE LEFT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES |
| 93533 | COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT HEART CATHETERIZATION THROUGH EXISTING SEPTAL OPENING, WITH OR WITHOUT RETROGRADE LEFT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES |
| 93563 | INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION INCLUDING IMAGING SUPERVISION, INTERPRETATION, AND REPORT; FOR SELECTIVE CORONARY ANGIOGRAPHY DURING CONGENITAL HEART CATHETERIZATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 93564 | INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION INCLUDING IMAGING SUPERVISION, INTERPRETATION, AND REPORT; FOR SELECTIVE OPACIFICATION OF AORTOCORONARY VENOUS OR ARTERIAL BYPASS GRAFT(S) (EG, AORTOCORONARY SAPHENOUS VEIN, FREE RADIAL ARTERY, OR FREE MAMMARY ARTERY GRAFT) TO ONE OR MORE CORONARY ARTERIES AND IN SITU ARTERIAL CONDUITS (EG, INTERNAL MAMMARY), WHETHER NATIVE OR USED FOR BYPASS TO ONE OR MORE CORONARY ARTERIES DURING CONGENITAL HEART CATHETERIZATION, WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 93565 | INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION INCLUDING IMAGING SUPERVISION, INTERPRETATION, AND REPORT; FOR SELECTIVE LEFT VENTRICULAR OR LEFT ATRIAL ANGIOGRAPHY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 93566 | INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION INCLUDING IMAGING SUPERVISION, INTERPRETATION, AND REPORT; FOR SELECTIVE RIGHT VENTRICULAR OR RIGHT ATRIAL ANGIOGRAPHY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 93567 | INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION INCLUDING IMAGING SUPERVISION, INTERPRETATION, AND REPORT; FOR SUPRAVALVULAR AORTOGRAPHY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 93568 | INJECTION PROCEDURE DURING CARDIAC CATHETERIZATION INCLUDING IMAGING SUPERVISION, INTERPRETATION, AND REPORT; FOR PULMONARY ANGIOGRAPHY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
ICD-9 Codes that Support Medical Necessity
Cardiac Catheterization/Coronary Angiography (93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461)
| 074.20 - 074.23 | COXSACKIE CARDITIS UNSPECIFIED - COXSACKIE MYOCARDITIS |
| 093.1 - 093.82 | SYPHILITIC AORTITIS - SYPHILITIC MYOCARDITIS |
| 098.83 - 098.84 | GONOCOCCAL PERICARDITIS - GONOCOCCAL ENDOCARDITIS |
| 112.81 | CANDIDAL ENDOCARDITIS |
| 115.03 | HISTOPLASMA CAPSULATUM PERICARDITIS |
| 115.04 | HISTOPLASMA CAPSULATUM ENDOCARDITIS |
| 115.13 | HISTOPLASMA DUBOISII PERICARDITIS |
| 115.14 | HISTOPLASMA DUBOISII ENDOCARDITIS |
| 130.3 | MYOCARDITIS DUE TO TOXOPLASMOSIS |
| 164.1 | MALIGNANT NEOPLASM OF HEART |
| 198.89 | SECONDARY MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES |
| 212.7 | BENIGN NEOPLASM OF HEART |
| 238.8 | NEOPLASM OF UNCERTAIN BEHAVIOR OF OTHER SPECIFIED SITES |
| 239.89 | NEOPLASMS OF UNSPECIFIED NATURE, OTHER SPECIFIED SITES |
| 391.0 - 392.0 | ACUTE RHEUMATIC PERICARDITIS - RHEUMATIC CHOREA WITH HEART INVOLVEMENT |
| 394.0 - 394.9 | MITRAL STENOSIS - OTHER AND UNSPECIFIED MITRAL VALVE DISEASES |
| 395.0 - 395.9 | RHEUMATIC AORTIC STENOSIS - OTHER AND UNSPECIFIED RHEUMATIC AORTIC DISEASES |
| 396.0 - 396.9 | MITRAL VALVE STENOSIS AND AORTIC VALVE STENOSIS - MITRAL AND AORTIC VALVE DISEASES UNSPECIFIED |
| 397.0 - 397.9 | DISEASES OF TRICUSPID VALVE - RHEUMATIC DISEASES OF ENDOCARDIUM VALVE UNSPECIFIED |
| 398.0 - 398.91 | RHEUMATIC MYOCARDITIS - RHEUMATIC HEART FAILURE (CONGESTIVE) |
| 410.00 - 410.82 | ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES SUBSEQUENT EPISODE OF CARE |
| 410.90 - 410.92 | ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE EPISODE OF CARE UNSPECIFIED - ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE SUBSEQUENT EPISODE OF CARE |
| 411.0 - 411.89 | POSTMYOCARDIAL INFARCTION SYNDROME - OTHER ACUTE AND SUBACUTE FORMS OF ISCHEMIC HEART DISEASE OTHER |
| 412 | OLD MYOCARDIAL INFARCTION |
| 413.0 - 413.9 | ANGINA DECUBITUS - OTHER AND UNSPECIFIED ANGINA PECTORIS |
| 414.00 - 414.9 | CORONARY ATHEROSCLEROSIS OF UNSPECIFIED TYPE OF VESSEL NATIVE OR GRAFT - CHRONIC ISCHEMIC HEART DISEASE UNSPECIFIED |
| 415.0 - 415.19 | ACUTE COR PULMONALE - OTHER PULMONARY EMBOLISM AND INFARCTION |
| 416.0 - 416.9 | PRIMARY PULMONARY HYPERTENSION - CHRONIC PULMONARY HEART DISEASE UNSPECIFIED |
| 417.0 - 417.1 | ARTERIOVENOUS FISTULA OF PULMONARY VESSELS - ANEURYSM OF PULMONARY ARTERY |
| 420.0 - 420.99 | ACUTE PERICARDITIS IN DISEASES CLASSIFIED ELSEWHERE - OTHER ACUTE PERICARDITIS |
| 421.0 - 421.9 | ACUTE AND SUBACUTE BACTERIAL ENDOCARDITIS - ACUTE ENDOCARDITIS UNSPECIFIED |
| 422.0 - 422.99 | ACUTE MYOCARDITIS IN DISEASES CLASSIFIED ELSEWHERE - OTHER ACUTE MYOCARDITIS |
| 423.0 - 423.9 | HEMOPERICARDIUM - UNSPECIFIED DISEASE OF PERICARDIUM |
| 424.0 - 424.99 | MITRAL VALVE DISORDERS - OTHER ENDOCARDITIS VALVE UNSPECIFIED |
| 425.0 - 425.9 | ENDOMYOCARDIAL FIBROSIS - SECONDARY CARDIOMYOPATHY UNSPECIFIED |
| 426.0 - 427.9 | ATRIOVENTRICULAR BLOCK COMPLETE - CARDIAC DYSRHYTHMIA UNSPECIFIED |
| 428.0 - 428.9 | CONGESTIVE HEART FAILURE UNSPECIFIED - HEART FAILURE UNSPECIFIED |
| 429.0 - 429.1 | MYOCARDITIS UNSPECIFIED - MYOCARDIAL DEGENERATION |
| 429.3 - 429.79 | CARDIOMEGALY - CERTAIN SEQUELAE OF MYOCARDIAL INFARCTION NOT ELSEWHERE CLASSIFIED OTHER |
| 429.81 - 429.83 | OTHER DISORDERS OF PAPILLARY MUSCLE - TAKOTSUBO SYNDROME |
| 429.89 - 429.9 | OTHER ILL-DEFINED HEART DISEASES - HEART DISEASE UNSPECIFIED |
| 441.4 - 441.9 | ABDOMINAL ANEURYSM WITHOUT RUPTURE - AORTIC ANEURYSM OF UNSPECIFIED SITE WITHOUT RUPTURE |
| 745.0 - 747.49 | COMMON TRUNCUS - OTHER ANOMALIES OF GREAT VEINS |
| 785.2 - 785.3 | UNDIAGNOSED CARDIAC MURMURS - OTHER ABNORMAL HEART SOUNDS |
| 785.51 | CARDIOGENIC SHOCK |
| 786.50 - 786.59 | UNSPECIFIED CHEST PAIN - OTHER CHEST PAIN |
| 794.30 - 794.39 | UNSPECIFIED ABNORMAL FUNCTION STUDY OF CARDIOVASCULAR SYSTEM - OTHER NONSPECIFIC ABNORMAL FUNCTION STUDY OF CARDIOVASCULAR SYSTEM |
| 795.4 | OTHER NONSPECIFIC ABNORMAL HISTOLOGICAL FINDINGS |
| 960.7 | POISONING BY ANTINEOPLASTIC ANTIBIOTICS |
| 996.83 | COMPLICATIONS OF TRANSPLANTED HEART |
| 997.1 | CARDIAC COMPLICATIONS NOT ELSEWHERE CLASSIFIED |
| 998.00 - 998.09 | POSTOPERATIVE SHOCK, UNSPECIFIED - POSTOPERATIVE SHOCK, OTHER |
| V42.1 | HEART REPLACED BY TRANSPLANT |
| V42.2 | HEART VALVE REPLACED BY TRANSPLANT |
| V47.2 | OTHER CARDIORESPIRATORY PROBLEMS |
| V58.11 | ENCOUNTER FOR ANTINEOPLASTIC CHEMOTHERAPY |
| V58.12 | ENCOUNTER FOR IMMUNOTHERAPY FOR NEOPLASTIC CONDITION |
| V67.2 | FOLLOW-UP EXAMINATION FOLLOWING CHEMOTHERAPY |
| V72.81 | PRE-OPERATIVE CARDIOVASCULAR EXAMINATION |
| 745.0 - 747.49 | COMMON TRUNCUS - OTHER ANOMALIES OF GREAT VEINS |
| 785.2 - 785.3 | UNDIAGNOSED CARDIAC MURMURS - OTHER ABNORMAL HEART SOUNDS |
| 794.30 - 794.39 | UNSPECIFIED ABNORMAL FUNCTION STUDY OF CARDIOVASCULAR SYSTEM - OTHER NONSPECIFIC ABNORMAL FUNCTION STUDY OF CARDIOVASCULAR SYSTEM |
Diagnoses that Support Medical Necessity
ICD-9 Codes that DO NOT Support Medical Necessity
N/A
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
Diagnoses that DO NOT Support Medical Necessity
Any ICD-9 code that is not listed above
General Information
The patients medical
records should be legible, contain the relevant history and physical
findings conforming to the criteria stated in the "Indications and
Limitations of Coverage and/or Medical Necessity" section of this
policy. The documentation must fully support the medical necessity for
the cardiac catheterization procedure(s), coronary angiography, and
injection procedure(s) that have been performed.
All services should have a formal procedural and interpretation report. These reports may be requested to support the medical necessity of the service rendered
Presence of a covered indication for right heart catheterization must be clearly documented in the medical record when right heart catheterization is billed.
The medical record must be made available to Medicare upon request.
When, the documentation does not meet the criteria for the service rendered or the documentation does not establish the medical necessity for the services, such services will be denied as "not reasonable and necessary" under Section 1862(a)(1) of the Social Security Act.
When requesting a written redetermination (formerly appeal), please send all relevant documentation with the request.
Appendices
All services should have a formal procedural and interpretation report. These reports may be requested to support the medical necessity of the service rendered
Presence of a covered indication for right heart catheterization must be clearly documented in the medical record when right heart catheterization is billed.
The medical record must be made available to Medicare upon request.
When, the documentation does not meet the criteria for the service rendered or the documentation does not establish the medical necessity for the services, such services will be denied as "not reasonable and necessary" under Section 1862(a)(1) of the Social Security Act.
When requesting a written redetermination (formerly appeal), please send all relevant documentation with the request.
In the American
College of Cardiology/Society for Cardiac Angiography and Interventions
expert consensus document, the following is stated. The routine use of
right-heart catheterization, in a patient whose symptoms and objective
studies suggest coronary artery disease without associated mitral
regurgitation or congestive failure, is discouraged. The additional
information gained from a right-heart catheterization in patients with
chest pain and suspected coronary artery disease is minimal.
Sources of Information and Basis for Decision
1. Antman EM, Anbe
DT et al ACC/AHA guidelines for the management of patients with
ST-elevation myocardial infarction: executive summary: a report of the
ACC/AHA Task Force on Practice Guidelines (Committee to Revise the 1999
Guidelines on the Management of Patients With Acute Myocardial
Infarction). Circulation 2004; 110:588-636.
2. Bashore TM, Bates ER et al Cardiac catheterization laboratory standards: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents (ACC/SCA&I Committee to Develop an Expert Consensus Document on Cardiac Catheterization Laboratory Standards). J Am Coll Cardiol 2001; 37:2170 -214.
3. Bonow RO, Carabello BA, et al 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Valvular Heart Disease 0. J Am Coll Cardiol
2008; 52:e1-142.
4. CJ Pepine, HD Allen, et al ACC/AHA guidelines for cardiac catheterization and cardiac catheterization laboratories. American College of Cardiology/American Heart Association Ad Hoc Task Force on Cardiac Catheterization Circulation 1991; 84;2213-2247
5. Other Contractor's policies
6. Scanlon PJ, Faxon DP, et al ACC/AHA guidelines for coronary angiography: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography). J Am Coll Cardiol 1999; 33:1756-824
Advisory Committee Meeting Notes
2. Bashore TM, Bates ER et al Cardiac catheterization laboratory standards: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents (ACC/SCA&I Committee to Develop an Expert Consensus Document on Cardiac Catheterization Laboratory Standards). J Am Coll Cardiol 2001; 37:2170 -214.
3. Bonow RO, Carabello BA, et al 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Valvular Heart Disease 0. J Am Coll Cardiol
2008; 52:e1-142.
4. CJ Pepine, HD Allen, et al ACC/AHA guidelines for cardiac catheterization and cardiac catheterization laboratories. American College of Cardiology/American Heart Association Ad Hoc Task Force on Cardiac Catheterization Circulation 1991; 84;2213-2247
5. Other Contractor's policies
6. Scanlon PJ, Faxon DP, et al ACC/AHA guidelines for coronary angiography: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography). J Am Coll Cardiol 1999; 33:1756-824
Meeting Date:
Wisconsin: 02/12/2010
Illinois: 01/13/2010
Michigan: 01/27/2010
Minnesota: 01/14/2010
J5 MAC
IA, KS, MO, NE, 02/19/2010
Open Meeting 01/06/2010
Start Date of Comment Period
Wisconsin: 02/12/2010
Illinois: 01/13/2010
Michigan: 01/27/2010
Minnesota: 01/14/2010
J5 MAC
IA, KS, MO, NE, 02/19/2010
Open Meeting 01/06/2010
02/19/2010
End Date of Comment Period
04/05/2010
Start Date of Notice Period
06/01/2010
Revision History Number
X
Revision History Explanation
8/1/2010 - The description for Revenue code 0321 was changed
8/1/2010 - The description for Revenue code 0323 was changed
8/1/2010 - The description for Revenue code 0360 was changed
8/1/2010 - The description for Revenue code 0369 was changed
8/1/2010 - The description for Revenue code 0480 was changed
8/1/2010 - The description for Revenue code 0481 was changed
8/1/2010 - The description for Revenue code 0519 was changed
8/1/2010 - The description for Revenue code 0520 was changed
8/1/2010 - The description for Revenue code 0521 was changed
8/1/2010 - The description for Revenue code 0522 was changed
8/1/2010 - The description for Revenue code 0523 was changed
8/1/2010 - The description for Revenue code 0524 was changed
8/1/2010 - The description for Revenue code 0525 was changed
8/1/2010 - The description for Revenue code 0526 was changed
8/1/2010 - The description for Revenue code 0527 was changed
8/1/2010 - The description for Revenue code 0528 was changed
8/1/2010 - The description for Revenue code 0529 was changed
10/18/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Colorado, New Mexico, Oklahoma and Texas were removed from this LCD because claims processing for those states are transitioning from FI Wisconsin Physicians Service (52280) to MAC Part A Trailblazer (04901).
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
93530 descriptor was changed in Group 1
93531 descriptor was changed in Group 1
93532 descriptor was changed in Group 1
93533 descriptor was changed in Group 1
11/21/2010 - The following CPT/HCPCS codes were deleted:
93501 was deleted from Group 1
93508 was deleted from Group 1
93510 was deleted from Group 1
93511 was deleted from Group 1
93514 was deleted from Group 1
93524 was deleted from Group 1
93526 was deleted from Group 1
93527 was deleted from Group 1
93528 was deleted from Group 1
93529 was deleted from Group 1
93539 was deleted from Group 1
93540 was deleted from Group 1
93541 was deleted from Group 1
93542 was deleted from Group 1
93543 was deleted from Group 1
93544 was deleted from Group 1
93545 was deleted from Group 1
93555 was deleted from Group 1
93556 was deleted from Group 1
01/01/2011 CPT code update added codes 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93462, 93463, 93563, 93564, 93565, 93566, 93567, 93568. Deleted codes 93501, 93508, 93510, 93511, 93514, 93524, 93526, 93527, 93528, 93529, 93539, 93540, 93541, 93542, 93543, 93544, 93545, 93555, 93556
02/21/2011 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Highmark (12901).
08/27/2011 - This policy was updated by the ICD-9 2011-2012 Annual Update.
10/01/2011 ICD-9 code updates added codes 998.00-998.09, codes 415.13, 414.4, 425.11, 425.18, 747.31, 747.32 and 747.39 added to ranges
Reason for Change
8/1/2010 - The description for Revenue code 0323 was changed
8/1/2010 - The description for Revenue code 0360 was changed
8/1/2010 - The description for Revenue code 0369 was changed
8/1/2010 - The description for Revenue code 0480 was changed
8/1/2010 - The description for Revenue code 0481 was changed
8/1/2010 - The description for Revenue code 0519 was changed
8/1/2010 - The description for Revenue code 0520 was changed
8/1/2010 - The description for Revenue code 0521 was changed
8/1/2010 - The description for Revenue code 0522 was changed
8/1/2010 - The description for Revenue code 0523 was changed
8/1/2010 - The description for Revenue code 0524 was changed
8/1/2010 - The description for Revenue code 0525 was changed
8/1/2010 - The description for Revenue code 0526 was changed
8/1/2010 - The description for Revenue code 0527 was changed
8/1/2010 - The description for Revenue code 0528 was changed
8/1/2010 - The description for Revenue code 0529 was changed
10/18/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Colorado, New Mexico, Oklahoma and Texas were removed from this LCD because claims processing for those states are transitioning from FI Wisconsin Physicians Service (52280) to MAC Part A Trailblazer (04901).
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
93530 descriptor was changed in Group 1
93531 descriptor was changed in Group 1
93532 descriptor was changed in Group 1
93533 descriptor was changed in Group 1
11/21/2010 - The following CPT/HCPCS codes were deleted:
93501 was deleted from Group 1
93508 was deleted from Group 1
93510 was deleted from Group 1
93511 was deleted from Group 1
93514 was deleted from Group 1
93524 was deleted from Group 1
93526 was deleted from Group 1
93527 was deleted from Group 1
93528 was deleted from Group 1
93529 was deleted from Group 1
93539 was deleted from Group 1
93540 was deleted from Group 1
93541 was deleted from Group 1
93542 was deleted from Group 1
93543 was deleted from Group 1
93544 was deleted from Group 1
93545 was deleted from Group 1
93555 was deleted from Group 1
93556 was deleted from Group 1
01/01/2011 CPT code update added codes 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93462, 93463, 93563, 93564, 93565, 93566, 93567, 93568. Deleted codes 93501, 93508, 93510, 93511, 93514, 93524, 93526, 93527, 93528, 93529, 93539, 93540, 93541, 93542, 93543, 93544, 93545, 93555, 93556
02/21/2011 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Highmark (12901).
08/27/2011 - This policy was updated by the ICD-9 2011-2012 Annual Update.
10/01/2011 ICD-9 code updates added codes 998.00-998.09, codes 415.13, 414.4, 425.11, 425.18, 747.31, 747.32 and 747.39 added to ranges
This LCD has no Related Documents.
LCD Attachments
Billing & Coding Guidelines 7/1/11 (PDF - 15 KB )
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Page Last Updated: Thursday, 20-Oct-2011 15:44:48 CDT
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