What is Procedure Code 93458?
The Current Procedural Terminology (CPT ®) code 93458 as maintained by American Medical Association, is a medical procedural code under the range - Cardiac Catheterization and Associated Procedures. Subscribe to Codify and get the code details in a flash. Request a Demo 14 Day Free Trial Buy Now Crosswalks MODIFIERS ICD-9-CM Vol1 CrossRef
What does 93458 stand for?
Under Cardiac Catheterization and Associated Procedures. The Current Procedural Terminology (CPT ®) code 93458 as maintained by American Medical Association, is a medical procedural code under the range - Cardiac Catheterization and Associated Procedures.
What is CPT 93458?
CPT code 93458 – Left Heart Catheterization with Coronaries. CPT code 93459 – Left Heart Catheterization along with Coronaries and Bypass. What is the CPT code for a left heart catheterization?
What does 93458 mean?
What does CPT code 93458 mean? 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.
What is ICD 10 code for left heart catheterization?
4A023NZLeft Cardiac Catheterization with PTCA The ICD-10-PCS code assignment for this case example is: 4A023NZ, Catheterization, Heart.
What is the ICD 10 code for cardiac catheterization?
0 for Cardiac catheterization as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure is a medical classification as listed by WHO under the range - Complications of medical and surgical care .
Does Medicare cover right heart catheterization?
Medicare Part B covers only the professional component of cardiac catheterization and coronary angiography procedures, when they are performed in hospital inpatient and outpatient facility settings.
What is included in CPT 93458?
CPT® Code 93458 in section: Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography.
Is CPT code 93458 considered surgery?
The Current Procedural Terminology (CPT®) code 93458 as maintained by American Medical Association, is a medical procedural code under the range - Cardiac Catheterization and Associated Procedures.
What is the ICD-10 for CAD?
Code I25* is the diagnosis code used for Chronic Ischemic Heart Disease, also known as Coronary artery disease (CAD). It is a is a group of diseases that includes: stable angina, unstable angina, myocardial infarction, and sudden coronary death.
Does Medicare require prior authorization for cardiac catheterization?
No. Prior authorization isn't required when Medicare Advantage is secondary to any other payer. Who is responsible for requesting prior authorization for a cardiac procedure? The ordering care provider's office is responsible for requesting a prior authorization number before scheduling the cardiac procedure.
Can CPT code 92928 and 93458 be billed together?
There are certain circumstances where 92928(PCI stent) and 92458(cardiac cath) can be billed together, I have successfully done this, I code the 92928 first (has the higher RVU) and then the 93458 with 26,xs,51.
What is the difference between 93454 and 93458?
93460 involves a left and right heart catheterization, while 93458 involves only an LHC. 93454 does not involve a catheterization, but instead simply a closure device angiography. Make sure you don't code any closure devices separately, as they are included in this code.
What is the difference between CPT 93452 and 93458?
It appears that if physician performs a LHC including inj/interp of angios and LV than 93458 would be used and 93452 will be used only when the physician performs an LV with no angio of coronaries or is this backwards. I am pulling my hair out regarding these two codes what they would be replacing.
How do you code left heart catheterization?
CPT code 93452 – Left Heart Catheterization.
What is CPT code for a right and left heart cath?
CPT Description 93453 Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed 93452; 93454-93461 Various descriptions – see Page 2.
Is there a reimbursement for a right heart catheterization?
There is no additional reimbursement for a right heart catheterization done for reasons other than hemodynamic evaluation. Studies done in conjunction with electrophysiologic tests, HIS bundle studies, pacing studies, temporary pacemaker insertion and endomyocardial biopsy are not separately payable.
Is right heart catheterization indicated for heart failure?
This procedure is done in a cardiac catheterization laboratory or interventional radiology laboratory and does not include a “bedside placement” of a flow directed (Swan-Ganz type) catheter. Right heart catheterization is not indicate d for: Atherosclerotic heart disease without heart failure.
Is aortography reimbursable for heart disease?
Aortography is reimbursable only for diagnoses of aortic root disease, valvular heart disease or congenital heart disease. It is not reimbursable for atherosclerotic heart disease. Angiograms to visualize the coronary ostia are included as part of coronary angiography.
When is the code 93503 used?
When a catheter is placed in the right heart for medically necessary monitoring purposes , the code 93503 must be reported. The codes describing a right heart catheterization (e.g., 93451) are used only for medically necessary diagnostic procedures.
What is a cardiac catheter?
Cardiac catheterization is a procedure that allows the doctor to see how well your blood vessels supply your heart. This process is used to diagnose and treat certain cardiovascular conditions. During this procedure, a catheter (long thin tube) is inserted in an artery or vein in your groin, neck, or arm and threaded through your blood vessels ...
Do add on codes need preauthorization?
Moreover, These Add-on codes need not require preauthorization, as well as these Add-on codes, may be used with other procedures. Moreover, some services are also included in cardiac catheterization for the above codes.
Can you do an endomyocardial biopsy separately?
Moreover, Endomyocardial biopsy (93505) may be separately allowed when performed independently or in addition to a cardiac catheterization procedure, when medical necessity is met, for instance, pre or post heart or heart/lung transplant, suspected doxorubicin myotoxicity, in the presence of, or suspected heart neoplasm.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Title XVIII of the Social Security Act (SSA), 1862 (a) (1) (A), states that no Medicare payment shall be made 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.” Title XVIII of the Social Security Act, 1862 (a) (7) and 42 Code of Federal Regulations, Section 411.15, exclude routine physical examinations. Title XVIII of the Social Security Act, 1833 (e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim. CMS Manual System, Pub.
Article Guidance
Article Text The following coding and billing guidance is to be used with its associated Local coverage determination. Supportive documentation evidencing the condition and treatment is expected to be documented in the medical record and be available upon request. Documentation in the patient’s medical record must substantiate the medical necessity of the service, including the following: • A clinical diagnosis, • The specific reason for the study, • Reason for performing a stress echocardiogram as opposed to only an electrical stress test, • The reason for using any pharmacological stress, and • The reason for a stress echocardiogram if a stress nuclear test is also performed for the same patient for the same clinical condition. Document the referral order (written or verbal) in the patient’s medical record.
ICD-10-CM Codes that Support Medical Necessity
The following list of ICD-10-CM codes applies to cardiovascular stress testing CPT codes 93015, 93016, 93017, 93018, 93350, 93351 93352 and J0153. Since J0395, J1245, and J1250 may be billed for indications other than pharmacological stress agents with cardiovascular testing, the use of these drugs is not subject to the following list of ICD-10-CM diagnoses:.
ICD-10-CM Codes that DO NOT Support Medical Necessity
Any diagnosis inconsistent with the Indications and Limitations of Coverage and/or Medical Necessity section, or the ICD-10-CM descriptors in the ICD-10-CM Codes That Support Medical Necessity section.
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 article does not apply to that Bill Type.
Revenue 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 article, services reported under other Revenue Codes are equally subject to this coverage determination.
What is Medicare reimbursement rate?
A Medicare reimbursement rate is the amount of money that Medicare pays doctors and other health care providers for the services and items they administer to Medicare beneficiaries. CPT codes are the numeric codes used to identify different medical services, procedures and items for billing purposes. When a health care provider bills Medicare ...
What is the difference between CPT and HCPCS?
The CPT codes used to bill for medical services and items are part of a larger coding system called the Healthcare Common Procedure Coding System (HCPCS). CPT codes consist of 5 numeric digits, while HCPCS codes ...
How much does Medicare pay for coinsurance?
In fact, Medicare’s reimbursement rate is generally around only 80% of the total bill as the beneficiary is typically responsible for paying the remaining 20% as coinsurance. Medicare predetermines what it will pay health care providers for each service or item. This cost is sometimes called the allowed amount but is more commonly referred ...
How much more can a health care provider charge than the Medicare approved amount?
Certain health care providers maintain a contract agreement with Medicare that allows them to charge up to 15% more than the Medicare-approved amount in what is called an “excess charge.”.
Is it a good idea to check your Medicare bill?
It’s a good idea for Medicare beneficiaries to review their medical bills in detail. Medicare fraud is not uncommon, and a quick check of your HCPCS codes can verify whether or not you were correctly billed for the care you received.
