Superseded Local Coverage Article Billing and Coding

Billing and Coding: Cardiac Catheterization and Coronary Angiography

A56500

Expand All | Collapse All
Superseded
To see the currently-in-effect version of this document, go to the section.

Contractor Information

Article Information

General Information

Article ID
A56500
Article Title
Billing and Coding: Cardiac Catheterization and Coronary Angiography
Article Type
Billing and Coding
Original Effective Date
10/01/2018
Revision Effective Date
01/01/2022
Revision Ending Date
09/30/2022
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2022 American Dental Association. All rights reserved.

Copyright © 2022, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy L33959 Cardiac Catheterization and Coronary Angiography.

 

General Guidelines for Claims submitted to Part A or Part B MAC:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.

 

Advance Beneficiary Notice of Non-coverage (ABN) Modifier Guidelines

An ABN may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.

Effective from April 1, 2010, non-covered services should be billed with modifier –GA, -GX, -GY, or –GZ, as appropriate.

The –GA modifier (“Waiver of Liability Statement Issued as Required by Payer Policy”) should be used when physicians, practitioners, or suppliers want to indicate that they anticipate that Medicare will deny a specific service as not reasonable and necessary and they do have an ABN signed by the beneficiary on file. Modifier GA applies only when services will be denied under reasonable and necessary provisions, sections 1862(a)(1), 1862(a)(9), 1879(e), or 1879(g) of the Social Security Act. Effective April 1, 2010, Part A MAC systems will automatically deny services billed with modifier GA. An ABN, Form CMS-R-131, should be signed by the beneficiary to indicate that ‎he/she accepts responsibility for payment.‎ The -GA modifier may also be used on assigned claims when a patient refuses to sign the ABN and the latter is properly witnessed. For claims submitted to the Part A MAC, occurrence code 32 and the date of the ABN is required.

 

Modifier GX (“Notice of Liability Issued, Voluntary Under Payer Policy”) should be used when the beneficiary has signed an ABN, and a denial is anticipated based on provisions other than medical necessity, such as statutory exclusions of coverage or technical issues. An ABN is not required for these denials, but if non-covered services are reported with modifier GX, will automatically be denied services.

 

The –GZ modifier should be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary and they have not had an ABN signed by the beneficiary. ‎If the service is statutorily non-covered, or without a benefit category, submit the ‎appropriate CPT/HCPCS code with the -GY modifier. An ABN is not required for these denials, and the limitation of liability does not apply for beneficiaries. Services with modifier GY will automatically deny.

Documentation Requirements

The patient’s medical record should include but is not limited to:

  • The assessment of the patient by the ordering provider as it relates to the complaint of the patient for that visit,
  • Relevant medical history
  • Results of pertinent tests/procedures
  • Signed and dated office visit record/operative report (Please note that all services ordered or rendered to Medicare beneficiaries must be signed.)

Other Comments:

For claims submitted to the Part A MAC: this coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated CGS to process their claims.


Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes

 

Associated Information:

1. Each claim must be submitted with ICD-10-CM codes that reflect the condition of the patient, and indicate the reason(s) for which the service was performed.
2. The patient’s medical record should contain documentation that fully supports the medical necessity for cardiac catheterization and coronary angiography as it is covered by Medicare. This documentation includes, but is not limited to, relevant medical history, physical examination and results of pertinent diagnostic tests or procedures.
3. The medical record should contain a formal procedure report and interpretation for each procedure performed.
4. The record must include documentation of the medical decision making when interventional procedures are not performed during the same session as the diagnostic procedures.
5. The medical record must include documentation of the medical necessity for each procedure when multiple catheterization and angiographic procedures are performed during the same session.
6. The medical record must include an interpretation and report of all angiograms. Imaging for each angiographic procedure (film, video or digital) must be retained in the medical record and be available for review by the Medicare contractor.
7. The medical record must include documentation of request for extra-cardiac angiography from the referring/ordering provider treating the patient.
8. Medical records must be made available to Medicare upon request.


Not applicable

Diagnostic coronary angiography may not be billed when performed during percutaneous coronary intervention, if it has been previously performed within the past six months resulting in the decision for the beneficiary to undergo the specific interventional procedure

Coding Information

CPT/HCPCS Codes

Group 1

(33 Codes)
Group 1 Paragraph

The following CPT/HCPCS codes describe cardiac catheterization.

Note: G0269 is considered a bundled code on the Medicare physician fee schedule and is not separately payable.

Group 1 Codes
CodeDescription
92978 ENDOLUMINAL IMAGING OF CORONARY VESSEL OR GRAFT USING INTRAVASCULAR ULTRASOUND (IVUS) OR OPTICAL COHERENCE TOMOGRAPHY (OCT) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION INCLUDING IMAGING SUPERVISION, INTERPRETATION AND REPORT; INITIAL VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
92979 ENDOLUMINAL IMAGING OF CORONARY VESSEL OR GRAFT USING INTRAVASCULAR ULTRASOUND (IVUS) OR OPTICAL COHERENCE TOMOGRAPHY (OCT) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION INCLUDING IMAGING SUPERVISION, INTERPRETATION AND REPORT; EACH ADDITIONAL VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
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)
93464 PHYSIOLOGIC EXERCISE STUDY (EG, BICYCLE OR ARM ERGOMETRY) INCLUDING ASSESSING HEMODYNAMIC MEASUREMENTS BEFORE AND AFTER (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
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)
93571 INTRAVASCULAR DOPPLER VELOCITY AND/OR PRESSURE DERIVED CORONARY FLOW RESERVE MEASUREMENT (CORONARY VESSEL OR GRAFT) DURING CORONARY ANGIOGRAPHY INCLUDING PHARMACOLOGICALLY INDUCED STRESS; INITIAL VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
93572 INTRAVASCULAR DOPPLER VELOCITY AND/OR PRESSURE DERIVED CORONARY FLOW RESERVE MEASUREMENT (CORONARY VESSEL OR GRAFT) DURING CORONARY ANGIOGRAPHY INCLUDING PHARMACOLOGICALLY INDUCED STRESS; EACH ADDITIONAL VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
93593 RIGHT HEART CATHETERIZATION FOR CONGENITAL HEART DEFECT(S) INCLUDING IMAGING GUIDANCE BY THE PROCEDURALIST TO ADVANCE THE CATHETER TO THE TARGET ZONE; NORMAL NATIVE CONNECTIONS
93594 RIGHT HEART CATHETERIZATION FOR CONGENITAL HEART DEFECT(S) INCLUDING IMAGING GUIDANCE BY THE PROCEDURALIST TO ADVANCE THE CATHETER TO THE TARGET ZONE; ABNORMAL NATIVE CONNECTIONS
93595 LEFT HEART CATHETERIZATION FOR CONGENITAL HEART DEFECT(S) INCLUDING IMAGING GUIDANCE BY THE PROCEDURALIST TO ADVANCE THE CATHETER TO THE TARGET ZONE, NORMAL OR ABNORMAL NATIVE CONNECTIONS
93596 RIGHT AND LEFT HEART CATHETERIZATION FOR CONGENITAL HEART DEFECT(S) INCLUDING IMAGING GUIDANCE BY THE PROCEDURALIST TO ADVANCE THE CATHETER TO THE TARGET ZONE(S); NORMAL NATIVE CONNECTIONS
93597 RIGHT AND LEFT HEART CATHETERIZATION FOR CONGENITAL HEART DEFECT(S) INCLUDING IMAGING GUIDANCE BY THE PROCEDURALIST TO ADVANCE THE CATHETER TO THE TARGET ZONE(S); ABNORMAL NATIVE CONNECTIONS
93598 CARDIAC OUTPUT MEASUREMENT(S), THERMODILUTION OR OTHER INDICATOR DILUTION METHOD, PERFORMED DURING CARDIAC CATHETERIZATION FOR THE EVALUATION OF CONGENITAL HEART DEFECTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
G0269 PLACEMENT OF OCCLUSIVE DEVICE INTO EITHER A VENOUS OR ARTERIAL ACCESS SITE, POST SURGICAL OR INTERVENTIONAL PROCEDURE (E.G., ANGIOSEAL PLUG, VASCULAR PLUG)

Group 2

(24 Codes)
Group 2 Paragraph

The following CPT codes describe SELECTIVE extra-cardiac angiography

Group 2 Codes
CodeDescription
36140 INTRODUCTION OF NEEDLE OR INTRACATHETER, UPPER OR LOWER EXTREMITY ARTERY
36200 INTRODUCTION OF CATHETER, AORTA
36215 SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; EACH FIRST ORDER THORACIC OR BRACHIOCEPHALIC BRANCH, WITHIN A VASCULAR FAMILY
36216 SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL SECOND ORDER THORACIC OR BRACHIOCEPHALIC BRANCH, WITHIN A VASCULAR FAMILY
36217 SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL THIRD ORDER OR MORE SELECTIVE THORACIC OR BRACHIOCEPHALIC BRANCH, WITHIN A VASCULAR FAMILY
36218 SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; ADDITIONAL SECOND ORDER, THIRD ORDER, AND BEYOND, THORACIC OR BRACHIOCEPHALIC BRANCH, WITHIN A VASCULAR FAMILY (LIST IN ADDITION TO CODE FOR INITIAL SECOND OR THIRD ORDER VESSEL AS APPROPRIATE)
36221 NON-SELECTIVE CATHETER PLACEMENT, THORACIC AORTA, WITH ANGIOGRAPHY OF THE EXTRACRANIAL CAROTID, VERTEBRAL, AND/OR INTRACRANIAL VESSELS, UNILATERAL OR BILATERAL, AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, INCLUDES ANGIOGRAPHY OF THE CERVICOCEREBRAL ARCH, WHEN PERFORMED
36222 SELECTIVE CATHETER PLACEMENT, COMMON CAROTID OR INNOMINATE ARTERY, UNILATERAL, ANY APPROACH, WITH ANGIOGRAPHY OF THE IPSILATERAL EXTRACRANIAL CAROTID CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, INCLUDES ANGIOGRAPHY OF THE CERVICOCEREBRAL ARCH, WHEN PERFORMED
36223 SELECTIVE CATHETER PLACEMENT, COMMON CAROTID OR INNOMINATE ARTERY, UNILATERAL, ANY APPROACH, WITH ANGIOGRAPHY OF THE IPSILATERAL INTRACRANIAL CAROTID CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, INCLUDES ANGIOGRAPHY OF THE EXTRACRANIAL CAROTID AND CERVICOCEREBRAL ARCH, WHEN PERFORMED
36224 SELECTIVE CATHETER PLACEMENT, INTERNAL CAROTID ARTERY, UNILATERAL, WITH ANGIOGRAPHY OF THE IPSILATERAL INTRACRANIAL CAROTID CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, INCLUDES ANGIOGRAPHY OF THE EXTRACRANIAL CAROTID AND CERVICOCEREBRAL ARCH, WHEN PERFORMED
36225 SELECTIVE CATHETER PLACEMENT, SUBCLAVIAN OR INNOMINATE ARTERY, UNILATERAL, WITH ANGIOGRAPHY OF THE IPSILATERAL VERTEBRAL CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, INCLUDES ANGIOGRAPHY OF THE CERVICOCEREBRAL ARCH, WHEN PERFORMED
36226 SELECTIVE CATHETER PLACEMENT, VERTEBRAL ARTERY, UNILATERAL, WITH ANGIOGRAPHY OF THE IPSILATERAL VERTEBRAL CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, INCLUDES ANGIOGRAPHY OF THE CERVICOCEREBRAL ARCH, WHEN PERFORMED
36227 SELECTIVE CATHETER PLACEMENT, EXTERNAL CAROTID ARTERY, UNILATERAL, WITH ANGIOGRAPHY OF THE IPSILATERAL EXTERNAL CAROTID CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
36228 SELECTIVE CATHETER PLACEMENT, EACH INTRACRANIAL BRANCH OF THE INTERNAL CAROTID OR VERTEBRAL ARTERIES, UNILATERAL, WITH ANGIOGRAPHY OF THE SELECTED VESSEL CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION (EG, MIDDLE CEREBRAL ARTERY, POSTERIOR INFERIOR CEREBELLAR ARTERY) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
36245 SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; EACH FIRST ORDER ABDOMINAL, PELVIC, OR LOWER EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR FAMILY
36246 SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL SECOND ORDER ABDOMINAL, PELVIC, OR LOWER EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR FAMILY
36247 SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL THIRD ORDER OR MORE SELECTIVE ABDOMINAL, PELVIC, OR LOWER EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR FAMILY
36248 SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; ADDITIONAL SECOND ORDER, THIRD ORDER, AND BEYOND, ABDOMINAL, PELVIC, OR LOWER EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR FAMILY (LIST IN ADDITION TO CODE FOR INITIAL SECOND OR THIRD ORDER VESSEL AS APPROPRIATE)
75625 AORTOGRAPHY, ABDOMINAL, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
75630 AORTOGRAPHY, ABDOMINAL PLUS BILATERAL ILIOFEMORAL LOWER EXTREMITY, CATHETER, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION
75635 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMINAL AORTA AND BILATERAL ILIOFEMORAL LOWER EXTREMITY RUNOFF, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, AND IMAGE POSTPROCESSING
75705 ANGIOGRAPHY, SPINAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION
75710 ANGIOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
75716 ANGIOGRAPHY, EXTREMITY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION

Group 3

(1 Code)
Group 3 Paragraph

The following HCPCS codes describe NON-SELECTIVE extra-cardiac angiography.

Group 3 Codes
CodeDescription
G0278 ILIAC AND/OR FEMORAL ARTERY ANGIOGRAPHY, NON-SELECTIVE, BILATERAL OR IPSILATERAL TO CATHETER INSERTION, PERFORMED AT THE SAME TIME AS CARDIAC CATHETERIZATION AND/OR CORONARY ANGIOGRAPHY, INCLUDES POSITIONING OR PLACEMENT OF THE CATHETER IN THE DISTAL AORTA OR IPSILATERAL FEMORAL OR ILIAC ARTERY, INJECTION OF DYE, PRODUCTION OF PERMANENT IMAGES, AND RADIOLOGIC SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE)

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(214 Codes)
Group 1 Paragraph

It is the responsibility of the provider to code to the highest level specified in ICD-10-CM. The correct use of an ICD-10-CM code does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria spcified in this determination.

 

ICD-10-CM codes that support medical necessity for Right Heart Catherization: CPT codes 93451, 93453, 93456, 93457, 93460, 93461

Group 1 Codes
CodeDescription
A18.84 Tuberculosis of heart
A39.50 - A39.52 Meningococcal carditis, unspecified - Meningococcal myocarditis
A52.03 Syphilitic endocarditis
A52.06 Other syphilitic heart involvement
A54.83 Gonococcal heart infection
A78 Q fever
B33.20 - B33.22 Viral carditis, unspecified - Viral myocarditis
B37.6 Candidal endocarditis
B39.4 Histoplasmosis capsulati, unspecified
B39.5 Histoplasmosis duboisii
B57.0 Acute Chagas' disease with heart involvement
B57.2 Chagas' disease (chronic) with heart involvement
C38.0 Malignant neoplasm of heart
C45.2 Mesothelioma of pericardium
D15.1 Benign neoplasm of heart
D86.85 Sarcoid myocarditis
E51.11 Dry beriberi
E51.12 Wet beriberi
E74.01 - E74.04 von Gierke disease - McArdle disease
E76.01 - E76.03 Hurler's syndrome - Scheie's syndrome
E76.1 Mucopolysaccharidosis, type II
E76.210 Morquio A mucopolysaccharidoses
E76.211 Morquio B mucopolysaccharidoses
E76.22 Sanfilippo mucopolysaccharidoses
E76.29 Other mucopolysaccharidoses
E76.3 Mucopolysaccharidosis, unspecified
E76.8 Other disorders of glucosaminoglycan metabolism
E76.9 Glucosaminoglycan metabolism disorder, unspecified
E84.0 Cystic fibrosis with pulmonary manifestations
E85.1 - E85.4 Neuropathic heredofamilial amyloidosis - Organ-limited amyloidosis
E85.81 Light chain (AL) amyloidosis
E85.82 Wild-type transthyretin-related (ATTR) amyloidosis
E85.89 Other amyloidosis
E85.9 Amyloidosis, unspecified
G11.10 Early-onset cerebellar ataxia, unspecified
G11.11 Friedreich ataxia
G71.00 Muscular dystrophy, unspecified
G71.01 Duchenne or Becker muscular dystrophy
G71.02 Facioscapulohumeral muscular dystrophy
G71.09 Other specified muscular dystrophies
G71.11 Myotonic muscular dystrophy
I01.0 - I01.2 Acute rheumatic pericarditis - Acute rheumatic myocarditis
I05.0 - I05.2 Rheumatic mitral stenosis - Rheumatic mitral stenosis with insufficiency
I05.9 Rheumatic mitral valve disease, unspecified
I06.0 - I06.2 Rheumatic aortic stenosis - Rheumatic aortic stenosis with insufficiency
I06.8 Other rheumatic aortic valve diseases
I06.9 Rheumatic aortic valve disease, unspecified
I07.0 - I07.2 Rheumatic tricuspid stenosis - Rheumatic tricuspid stenosis and insufficiency
I08.0 - I08.3 Rheumatic disorders of both mitral and aortic valves - Combined rheumatic disorders of mitral, aortic and tricuspid valves
I09.0 - I09.2 Rheumatic myocarditis - Chronic rheumatic pericarditis
I09.81 Rheumatic heart failure
I09.89 Other specified rheumatic heart diseases
I11.0 Hypertensive heart disease with heart failure
I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
I23.1 Atrial septal defect as current complication following acute myocardial infarction
I23.2 Ventricular septal defect as current complication following acute myocardial infarction
I23.4 Rupture of chordae tendineae as current complication following acute myocardial infarction
I23.5 Rupture of papillary muscle as current complication following acute myocardial infarction
I25.3 Aneurysm of heart
I26.01 Septic pulmonary embolism with acute cor pulmonale
I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
I26.09 Other pulmonary embolism with acute cor pulmonale
I26.90 Septic pulmonary embolism without acute cor pulmonale
I26.92 Saddle embolus of pulmonary artery without acute cor pulmonale
I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale
I26.94 Multiple subsegmental pulmonary emboli without acute cor pulmonale
I26.99 Other pulmonary embolism without acute cor pulmonale
I27.0 - I27.1 Primary pulmonary hypertension - Kyphoscoliotic heart disease
I27.20 Pulmonary hypertension, unspecified
I27.21 Secondary pulmonary arterial hypertension
I27.22 Pulmonary hypertension due to left heart disease
I27.23 Pulmonary hypertension due to lung diseases and hypoxia
I27.24 Chronic thromboembolic pulmonary hypertension
I27.29 Other secondary pulmonary hypertension
I27.81 Cor pulmonale (chronic)
I27.82 Chronic pulmonary embolism
I27.83 Eisenmenger's syndrome
I28.0 Arteriovenous fistula of pulmonary vessels
I28.1 Aneurysm of pulmonary artery
I28.8 Other diseases of pulmonary vessels
I28.9 Disease of pulmonary vessels, unspecified
I30.0 Acute nonspecific idiopathic pericarditis
I30.1 Infective pericarditis
I30.8 Other forms of acute pericarditis
I30.9 Acute pericarditis, unspecified
I31.0 - I31.3 Chronic adhesive pericarditis - Pericardial effusion (noninflammatory)
I31.8 Other specified diseases of pericardium
I31.9 Disease of pericardium, unspecified
I32 Pericarditis in diseases classified elsewhere
I33.0 Acute and subacute infective endocarditis
I33.9 Acute and subacute endocarditis, unspecified
I34.0 - I34.2 Nonrheumatic mitral (valve) insufficiency - Nonrheumatic mitral (valve) stenosis
I35.0 - I35.2 Nonrheumatic aortic (valve) stenosis - Nonrheumatic aortic (valve) stenosis with insufficiency
I36.0 - I36.2 Nonrheumatic tricuspid (valve) stenosis - Nonrheumatic tricuspid (valve) stenosis with insufficiency
I37.0 - I37.2 Nonrheumatic pulmonary valve stenosis - Nonrheumatic pulmonary valve stenosis with insufficiency
I38 Endocarditis, valve unspecified
I39 Endocarditis and heart valve disorders in diseases classified elsewhere
I40.0 Infective myocarditis
I40.1 Isolated myocarditis
I40.8 Other acute myocarditis
I40.9 Acute myocarditis, unspecified
I41 Myocarditis in diseases classified elsewhere
I42.0 - I42.9 Dilated cardiomyopathy - Cardiomyopathy, unspecified
I43 Cardiomyopathy in diseases classified elsewhere
I46.2 Cardiac arrest due to underlying cardiac condition
I46.8 Cardiac arrest due to other underlying condition
I47.0 Re-entry ventricular arrhythmia
I47.2 Ventricular tachycardia
I47.9 Paroxysmal tachycardia, unspecified
I49.01 Ventricular fibrillation
I49.02 Ventricular flutter
I50.1 Left ventricular failure, unspecified
I50.20 - I50.23 Unspecified systolic (congestive) heart failure - Acute on chronic systolic (congestive) heart failure
I50.30 - I50.33 Unspecified diastolic (congestive) heart failure - Acute on chronic diastolic (congestive) heart failure
I50.40 - I50.43 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure - Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I51.0 Cardiac septal defect, acquired
I51.1 Rupture of chordae tendineae, not elsewhere classified
I51.2 Rupture of papillary muscle, not elsewhere classified
I51.4 Myocarditis, unspecified
I51.5 Myocardial degeneration
I51.7 Cardiomegaly
I51.89 Other ill-defined heart diseases
I97.0 Postcardiotomy syndrome
I97.110 Postprocedural cardiac insufficiency following cardiac surgery
I97.111 Postprocedural cardiac insufficiency following other surgery
I97.120 Postprocedural cardiac arrest following cardiac surgery
I97.121 Postprocedural cardiac arrest following other surgery
I97.130 Postprocedural heart failure following cardiac surgery
I97.131 Postprocedural heart failure following other surgery
M32.11 Endocarditis in systemic lupus erythematosus
M32.12 Pericarditis in systemic lupus erythematosus
O90.3 Peripartum cardiomyopathy
Q21.0 Ventricular septal defect
Q21.1 Atrial septal defect
Q22.5 Ebstein's anomaly
R93.1 Abnormal findings on diagnostic imaging of heart and coronary circulation
T40.491A Poisoning by other synthetic narcotics, accidental (unintentional), initial encounter
T40.492A Poisoning by other synthetic narcotics, intentional self-harm, initial encounter
T40.493A Poisoning by other synthetic narcotics, assault, initial encounter
T40.494A Poisoning by other synthetic narcotics, undetermined, initial encounter
T80.0XXA Air embolism following infusion, transfusion and therapeutic injection, initial encounter
T81.10XA Postprocedural shock unspecified, initial encounter
T81.11XA Postprocedural cardiogenic shock, initial encounter
T81.718A Complication of other artery following a procedure, not elsewhere classified, initial encounter
T81.72XA Complication of vein following a procedure, not elsewhere classified, initial encounter
T82.09XA Other mechanical complication of heart valve prosthesis, initial encounter
T82.817A Embolism due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.818A Embolism due to vascular prosthetic devices, implants and grafts, initial encounter
T86.21 - T86.23 Heart transplant rejection - Heart transplant infection
T86.290 Cardiac allograft vasculopathy
T86.31 - T86.33 Heart-lung transplant rejection - Heart-lung transplant infection
Z48.21 Encounter for aftercare following heart transplant
Z48.280 Encounter for aftercare following heart-lung transplant
Z94.1 Heart transplant status

Group 2

(280 Codes)
Group 2 Paragraph

ICD-10-CM codes that support medical necessity for Left Heart Catherization: CPT codes 93452, 93453, 93458, 93459, 93460, 93461, 93571, 93572

Group 2 Codes
CodeDescription
A18.84 Tuberculosis of heart
A39.50 Meningococcal carditis, unspecified
A39.51 Meningococcal endocarditis
A39.52 Meningococcal myocarditis
A52.02 Syphilitic aortitis
A52.03 Syphilitic endocarditis
A52.06 Other syphilitic heart involvement
A54.83 Gonococcal heart infection
A78 Q fever
B33.20 - B33.22 Viral carditis, unspecified - Viral myocarditis
B37.6 Candidal endocarditis
B39.4 Histoplasmosis capsulati, unspecified
B39.5 Histoplasmosis duboisii
B57.0 Acute Chagas' disease with heart involvement
B57.2 Chagas' disease (chronic) with heart involvement
C38.0 Malignant neoplasm of heart
C45.2 Mesothelioma of pericardium
D15.1 Benign neoplasm of heart
D86.85 Sarcoid myocarditis
E51.11 Dry beriberi
E51.12 Wet beriberi
E64.9 Sequelae of unspecified nutritional deficiency
E74.01 - E74.04 von Gierke disease - McArdle disease
E76.01 - E76.03 Hurler's syndrome - Scheie's syndrome
E76.1 Mucopolysaccharidosis, type II
E76.210 Morquio A mucopolysaccharidoses
E76.211 Morquio B mucopolysaccharidoses
E76.219 Morquio mucopolysaccharidoses, unspecified
E76.22 Sanfilippo mucopolysaccharidoses
E76.29 Other mucopolysaccharidoses
E76.3 Mucopolysaccharidosis, unspecified
E76.8 Other disorders of glucosaminoglycan metabolism
E76.9 Glucosaminoglycan metabolism disorder, unspecified
E84.0 Cystic fibrosis with pulmonary manifestations
E85.1 - E85.4 Neuropathic heredofamilial amyloidosis - Organ-limited amyloidosis
E85.81 Light chain (AL) amyloidosis
E85.82 Wild-type transthyretin-related (ATTR) amyloidosis
E85.89 Other amyloidosis
E85.9 Amyloidosis, unspecified
E88.81 Metabolic syndrome
E88.9 Metabolic disorder, unspecified
G11.10 Early-onset cerebellar ataxia, unspecified
G11.11 Friedreich ataxia
G71.00 Muscular dystrophy, unspecified
G71.01 Duchenne or Becker muscular dystrophy
G71.02 Facioscapulohumeral muscular dystrophy
G71.09 Other specified muscular dystrophies
G71.11 Myotonic muscular dystrophy
I05.0 - I05.2 Rheumatic mitral stenosis - Rheumatic mitral stenosis with insufficiency
I05.8 Other rheumatic mitral valve diseases
I05.9 Rheumatic mitral valve disease, unspecified
I06.0 - I06.2 Rheumatic aortic stenosis - Rheumatic aortic stenosis with insufficiency
I06.8 Other rheumatic aortic valve diseases
I06.9 Rheumatic aortic valve disease, unspecified
I07.0 - I07.2 Rheumatic tricuspid stenosis - Rheumatic tricuspid stenosis and insufficiency
I08.0 - I08.3 Rheumatic disorders of both mitral and aortic valves - Combined rheumatic disorders of mitral, aortic and tricuspid valves
I08.8 Other rheumatic multiple valve diseases
I08.9 Rheumatic multiple valve disease, unspecified
I09.0 Rheumatic myocarditis
I09.1 Rheumatic diseases of endocardium, valve unspecified
I09.81 Rheumatic heart failure
I09.89 Other specified rheumatic heart diseases
I11.0 Hypertensive heart disease with heart failure
I20.0 Unstable angina
I20.1 Angina pectoris with documented spasm
I20.8 Other forms of angina pectoris
I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery
I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery
I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
I21.29 ST elevation (STEMI) myocardial infarction involving other sites
I21.3 ST elevation (STEMI) myocardial infarction of unspecified site
I21.4 Non-ST elevation (NSTEMI) myocardial infarction
I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall
I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall
I22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarction
I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites
I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
I23.0 - I23.7 Hemopericardium as current complication following acute myocardial infarction - Postinfarction angina
I24.0 Acute coronary thrombosis not resulting in myocardial infarction
I24.1 Dressler's syndrome
I24.8 Other forms of acute ischemic heart disease
I24.9 Acute ischemic heart disease, unspecified
I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris
I25.2 Old myocardial infarction
I25.3 Aneurysm of heart
I25.41 Coronary artery aneurysm
I25.42 Coronary artery dissection
I25.5 Ischemic cardiomyopathy
I25.6 Silent myocardial ischemia
I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
I25.719 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris
I25.720 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
I25.721 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
I25.729 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectoris
I25.730 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
I25.731 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
I25.739 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris
I25.750 Atherosclerosis of native coronary artery of transplanted heart with unstable angina
I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
I25.759 Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris
I25.760 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
I25.769 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris
I25.790 Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
I25.799 Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectoris
I25.810 Atherosclerosis of coronary artery bypass graft(s) without angina pectoris
I25.811 Atherosclerosis of native coronary artery of transplanted heart without angina pectoris
I25.812 Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris
I25.82 Chronic total occlusion of coronary artery
I25.84 Coronary atherosclerosis due to calcified coronary lesion
I25.9 Chronic ischemic heart disease, unspecified
I31.0 - I31.4 Chronic adhesive pericarditis - Cardiac tamponade
I31.8 Other specified diseases of pericardium
I31.9 Disease of pericardium, unspecified
I33.0 Acute and subacute infective endocarditis
I33.9 Acute and subacute endocarditis, unspecified
I34.0 - I34.2 Nonrheumatic mitral (valve) insufficiency - Nonrheumatic mitral (valve) stenosis
I35.0 - I35.2 Nonrheumatic aortic (valve) stenosis - Nonrheumatic aortic (valve) stenosis with insufficiency
I38 Endocarditis, valve unspecified
I39 Endocarditis and heart valve disorders in diseases classified elsewhere
I40.0 Infective myocarditis
I40.1 Isolated myocarditis
I40.8 Other acute myocarditis
I40.9 Acute myocarditis, unspecified
I41 Myocarditis in diseases classified elsewhere
I42.0 - I42.9 Dilated cardiomyopathy - Cardiomyopathy, unspecified
I43 Cardiomyopathy in diseases classified elsewhere
I46.2 Cardiac arrest due to underlying cardiac condition
I46.8 Cardiac arrest due to other underlying condition
I47.0 Re-entry ventricular arrhythmia
I47.2 Ventricular tachycardia
I47.9 Paroxysmal tachycardia, unspecified
I49.01 Ventricular fibrillation
I49.02 Ventricular flutter
I50.1 Left ventricular failure, unspecified
I50.20 - I50.23 Unspecified systolic (congestive) heart failure - Acute on chronic systolic (congestive) heart failure
I50.30 - I50.33 Unspecified diastolic (congestive) heart failure - Acute on chronic diastolic (congestive) heart failure
I50.40 - I50.43 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure - Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.9 Heart failure, unspecified
I51.0 - I51.5 Cardiac septal defect, acquired - Myocardial degeneration
I51.7 Cardiomegaly
I51.81 Takotsubo syndrome
I51.89 Other ill-defined heart diseases
I97.0 Postcardiotomy syndrome
I97.110 Postprocedural cardiac insufficiency following cardiac surgery
I97.111 Postprocedural cardiac insufficiency following other surgery
I97.120 Postprocedural cardiac arrest following cardiac surgery
I97.121 Postprocedural cardiac arrest following other surgery
I97.130 Postprocedural heart failure following cardiac surgery
I97.131 Postprocedural heart failure following other surgery
M05.311 Rheumatoid heart disease with rheumatoid arthritis of right shoulder
M05.312 Rheumatoid heart disease with rheumatoid arthritis of left shoulder
M05.321 Rheumatoid heart disease with rheumatoid arthritis of right elbow
M05.322 Rheumatoid heart disease with rheumatoid arthritis of left elbow
M05.331 Rheumatoid heart disease with rheumatoid arthritis of right wrist
M05.332 Rheumatoid heart disease with rheumatoid arthritis of left wrist
M05.341 Rheumatoid heart disease with rheumatoid arthritis of right hand
M05.342 Rheumatoid heart disease with rheumatoid arthritis of left hand
M05.351 Rheumatoid heart disease with rheumatoid arthritis of right hip
M05.352 Rheumatoid heart disease with rheumatoid arthritis of left hip
M05.361 Rheumatoid heart disease with rheumatoid arthritis of right knee
M05.362 Rheumatoid heart disease with rheumatoid arthritis of left knee
M05.371 Rheumatoid heart disease with rheumatoid arthritis of right ankle and foot
M05.372 Rheumatoid heart disease with rheumatoid arthritis of left ankle and foot
M05.39 Rheumatoid heart disease with rheumatoid arthritis of multiple sites
M06.1 Adult-onset Still's disease
M32.0 Drug-induced systemic lupus erythematosus
M32.11 - M32.13 Endocarditis in systemic lupus erythematosus - Lung involvement in systemic lupus erythematosus
O90.3 Peripartum cardiomyopathy
Q21.0 Ventricular septal defect
Q21.1 Atrial septal defect
Q23.3 Congenital mitral insufficiency
Q24.5 Malformation of coronary vessels
R07.2 Precordial pain
R07.82 Intercostal pain
R07.9 Chest pain, unspecified
R93.1 Abnormal findings on diagnostic imaging of heart and coronary circulation
R93.89 Abnormal findings on diagnostic imaging of other specified body structures
R94.39 Abnormal result of other cardiovascular function study
T40.491A Poisoning by other synthetic narcotics, accidental (unintentional), initial encounter
T40.492A Poisoning by other synthetic narcotics, intentional self-harm, initial encounter
T40.493A Poisoning by other synthetic narcotics, assault, initial encounter
T40.494A Poisoning by other synthetic narcotics, undetermined, initial encounter
T82.01XA Breakdown (mechanical) of heart valve prosthesis, initial encounter
T82.02XA Displacement of heart valve prosthesis, initial encounter
T82.03XA Leakage of heart valve prosthesis, initial encounter
T82.211A Breakdown (mechanical) of coronary artery bypass graft, initial encounter
T82.212A Displacement of coronary artery bypass graft, initial encounter
T82.213A Leakage of coronary artery bypass graft, initial encounter
T86.21 - T86.23 Heart transplant rejection - Heart transplant infection
T86.290 Cardiac allograft vasculopathy
T86.31 - T86.33 Heart-lung transplant rejection - Heart-lung transplant infection
Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Z48.21 Encounter for aftercare following heart transplant
Z48.280 Encounter for aftercare following heart-lung transplant
Z94.1 Heart transplant status
Z94.3 Heart and lungs transplant status
Z95.1 Presence of aortocoronary bypass graft
Z95.3 - Z95.5 Presence of xenogenic heart valve - Presence of coronary angioplasty implant and graft
Z98.61 Coronary angioplasty status

Group 3

(101 Codes)
Group 3 Paragraph

ICD-10-CM codes that support medical necessity for Coronary/Bypass Angiography without Left Heart Catherization: CPT codes 93454, 93455 93456, 93457, 93458, 93459, 93460, 93461, 93571, 93572

Group 3 Codes
CodeDescription
I20.0 Unstable angina
I20.1 Angina pectoris with documented spasm
I20.8 Other forms of angina pectoris
I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery
I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery
I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
I21.29 ST elevation (STEMI) myocardial infarction involving other sites
I21.3 ST elevation (STEMI) myocardial infarction of unspecified site
I21.4 Non-ST elevation (NSTEMI) myocardial infarction
I22.0 - I22.2 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall - Subsequent non-ST elevation (NSTEMI) myocardial infarction
I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites
I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
I23.0 - I23.3 Hemopericardium as current complication following acute myocardial infarction - Rupture of cardiac wall without hemopericardium as current complication following acute myocardial infarction
I23.6 Thrombosis of atrium, auricular appendage, and ventricle as current complications following acute myocardial infarction
I23.7 Postinfarction angina
I24.0 Acute coronary thrombosis not resulting in myocardial infarction
I24.1 Dressler's syndrome
I24.8 Other forms of acute ischemic heart disease
I24.9 Acute ischemic heart disease, unspecified
I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
I25.2 Old myocardial infarction
I25.41 Coronary artery aneurysm
I25.42 Coronary artery dissection
I25.5 Ischemic cardiomyopathy
I25.6 Silent myocardial ischemia
I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
I25.720 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
I25.721 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
I25.730 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
I25.731 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
I25.750 Atherosclerosis of native coronary artery of transplanted heart with unstable angina
I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
I25.760 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
I25.790 Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
I25.810 Atherosclerosis of coronary artery bypass graft(s) without angina pectoris
I25.811 Atherosclerosis of native coronary artery of transplanted heart without angina pectoris
I25.812 Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris
I25.82 Chronic total occlusion of coronary artery
I25.84 Coronary atherosclerosis due to calcified coronary lesion
I25.9 Chronic ischemic heart disease, unspecified
I51.0 Cardiac septal defect, acquired
I51.3 Intracardiac thrombosis, not elsewhere classified
I51.81 Takotsubo syndrome
I51.89 Other ill-defined heart diseases
I97.0 Postcardiotomy syndrome
I97.110 Postprocedural cardiac insufficiency following cardiac surgery
I97.111 Postprocedural cardiac insufficiency following other surgery
I97.120 Postprocedural cardiac arrest following cardiac surgery
I97.121 Postprocedural cardiac arrest following other surgery
I97.130 Postprocedural heart failure following cardiac surgery
I97.131 Postprocedural heart failure following other surgery
M32.0 Drug-induced systemic lupus erythematosus
M32.11 - M32.13 Endocarditis in systemic lupus erythematosus - Lung involvement in systemic lupus erythematosus
Q24.5 Malformation of coronary vessels
R07.2 Precordial pain
R07.82 Intercostal pain
R07.89 Other chest pain
R07.9 Chest pain, unspecified
R93.1 Abnormal findings on diagnostic imaging of heart and coronary circulation
R94.39 Abnormal result of other cardiovascular function study
T82.211A Breakdown (mechanical) of coronary artery bypass graft, initial encounter
T82.212A Displacement of coronary artery bypass graft, initial encounter
T82.213A Leakage of coronary artery bypass graft, initial encounter
T86.21 - T86.23 Heart transplant rejection - Heart transplant infection
T86.290 Cardiac allograft vasculopathy
T86.31 - T86.33 Heart-lung transplant rejection - Heart-lung transplant infection
Z01.810 Encounter for preprocedural cardiovascular examination
Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Z48.21 Encounter for aftercare following heart transplant
Z48.280 Encounter for aftercare following heart-lung transplant
Z94.1 Heart transplant status
Z94.3 Heart and lungs transplant status
Z95.1 Presence of aortocoronary bypass graft
Z95.5 Presence of coronary angioplasty implant and graft
Z98.61 Coronary angioplasty status

Group 4

(44 Codes)
Group 4 Paragraph

ICD-10-CM codes that support medical necessity for Congenital Heart Disease CPT codes: 93593, 93594, 93595,93596, 93597, 93598, 93563, 93564, 93565, 93566, 93567, 93568

Group 4 Codes
CodeDescription
Q20.0 - Q20.6 Common arterial trunk - Isomerism of atrial appendages
Q21.0 - Q21.4 Ventricular septal defect - Aortopulmonary septal defect
Q22.0 - Q22.2 Pulmonary valve atresia - Congenital pulmonary valve insufficiency
Q22.4 - Q22.6 Congenital tricuspid stenosis - Hypoplastic right heart syndrome
Q23.0 - Q23.4 Congenital stenosis of aortic valve - Hypoplastic left heart syndrome
Q24.2 - Q24.5 Cor triatriatum - Malformation of coronary vessels
Q25.0 Patent ductus arteriosus
Q25.1 Coarctation of aorta
Q25.21 Interruption of aortic arch
Q25.29 Other atresia of aorta
Q25.3 Supravalvular aortic stenosis
Q25.5 Atresia of pulmonary artery
Q25.6 Stenosis of pulmonary artery
Q25.71 Coarctation of pulmonary artery
Q25.72 Congenital pulmonary arteriovenous malformation
Q25.79 Other congenital malformations of pulmonary artery
Q25.8 Other congenital malformations of other great arteries
Q26.2 - Q26.4 Total anomalous pulmonary venous connection - Anomalous pulmonary venous connection, unspecified
Q26.9 Congenital malformation of great vein, unspecified
R93.1 Abnormal findings on diagnostic imaging of heart and coronary circulation
R93.89 Abnormal findings on diagnostic imaging of other specified body structures

Group 5

(47 Codes)
Group 5 Paragraph

ICD-10-CM codes that support medical necessity for Pulmonary/Right Heart Angiography CPT codes: 93566,93568

Group 5 Codes
CodeDescription
I26.01 Septic pulmonary embolism with acute cor pulmonale
I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
I26.90 Septic pulmonary embolism without acute cor pulmonale
I26.92 Saddle embolus of pulmonary artery without acute cor pulmonale
I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale
I26.94 Multiple subsegmental pulmonary emboli without acute cor pulmonale
I27.0 Primary pulmonary hypertension
I27.20 Pulmonary hypertension, unspecified
I27.21 Secondary pulmonary arterial hypertension
I27.22 Pulmonary hypertension due to left heart disease
I27.23 Pulmonary hypertension due to lung diseases and hypoxia
I27.24 Chronic thromboembolic pulmonary hypertension
I27.29 Other secondary pulmonary hypertension
I27.82 Chronic pulmonary embolism
I27.83 Eisenmenger's syndrome
I27.89 Other specified pulmonary heart diseases
I36.0 - I36.2 Nonrheumatic tricuspid (valve) stenosis - Nonrheumatic tricuspid (valve) stenosis with insufficiency
I37.0 - I37.2 Nonrheumatic pulmonary valve stenosis - Nonrheumatic pulmonary valve stenosis with insufficiency
J80 Acute respiratory distress syndrome
J96.01 Acute respiratory failure with hypoxia
J96.02 Acute respiratory failure with hypercapnia
J96.91 Respiratory failure, unspecified with hypoxia
J96.92 Respiratory failure, unspecified with hypercapnia
O08.2 Embolism following ectopic and molar pregnancy
Q22.0 - Q22.3 Pulmonary valve atresia - Other congenital malformations of pulmonary valve
Q22.5 Ebstein's anomaly
Q24.3 Pulmonary infundibular stenosis
Q24.8 Other specified congenital malformations of heart
Q25.5 Atresia of pulmonary artery
Q25.6 Stenosis of pulmonary artery
Q25.71 Coarctation of pulmonary artery
Q25.72 Congenital pulmonary arteriovenous malformation
Q25.79 Other congenital malformations of pulmonary artery
R93.1 Abnormal findings on diagnostic imaging of heart and coronary circulation
R93.89 Abnormal findings on diagnostic imaging of other specified body structures
T80.0XXA Air embolism following infusion, transfusion and therapeutic injection, initial encounter
T81.718A Complication of other artery following a procedure, not elsewhere classified, initial encounter
T81.72XA Complication of vein following a procedure, not elsewhere classified, initial encounter
T82.817A Embolism due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.818A Embolism due to vascular prosthetic devices, implants and grafts, initial encounter

Group 6

(9 Codes)
Group 6 Paragraph

ICD-10-CM codes that support medical necessity for Aortography CPT codes: 93567

Group 6 Codes
CodeDescription
A18.84 Tuberculosis of heart
I35.0 - I35.2 Nonrheumatic aortic (valve) stenosis - Nonrheumatic aortic (valve) stenosis with insufficiency
I35.8 Other nonrheumatic aortic valve disorders
I35.9 Nonrheumatic aortic valve disorder, unspecified
I38 Endocarditis, valve unspecified
I39 Endocarditis and heart valve disorders in diseases classified elsewhere
M32.11 Endocarditis in systemic lupus erythematosus

Group 7

(25 Codes)
Group 7 Paragraph

ICD-10-CM codes that support medical necessity for Endomyocardial Biopsy CPT code: 93505

Group 7 Codes
CodeDescription
A18.84 Tuberculosis of heart
I40.0 Infective myocarditis
I40.1 Isolated myocarditis
I40.8 Other acute myocarditis
I41 Myocarditis in diseases classified elsewhere
I42.0 Dilated cardiomyopathy
I42.3 - I42.5 Endomyocardial (eosinophilic) disease - Other restrictive cardiomyopathy
I42.8 Other cardiomyopathies
I42.9 Cardiomyopathy, unspecified
I43 Cardiomyopathy in diseases classified elsewhere
T86.21 Heart transplant rejection
T86.22 Heart transplant failure
T86.23 Heart transplant infection
T86.290 Cardiac allograft vasculopathy
T86.298 Other complications of heart transplant
T86.31 Heart-lung transplant rejection
T86.32 Heart-lung transplant failure
T86.33 Heart-lung transplant infection
Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Z48.21 Encounter for aftercare following heart transplant
Z48.280 Encounter for aftercare following heart-lung transplant
Z94.1 Heart transplant status
Z94.3 Heart and lungs transplant status

Group 8

(248 Codes)
Group 8 Paragraph

ICD-10-CM codes that support medical necessity for Swan-Ganz CPT code: 93503

Group 8 Codes
CodeDescription
A18.84 Tuberculosis of heart
E86.0 Dehydration
E86.1 Hypovolemia
E86.9 Volume depletion, unspecified
E87.71 Transfusion associated circulatory overload
E87.79 Other fluid overload
I05.0 - I05.2 Rheumatic mitral stenosis - Rheumatic mitral stenosis with insufficiency
I05.8 Other rheumatic mitral valve diseases
I06.0 - I06.2 Rheumatic aortic stenosis - Rheumatic aortic stenosis with insufficiency
I06.8 Other rheumatic aortic valve diseases
I07.0 - I07.2 Rheumatic tricuspid stenosis - Rheumatic tricuspid stenosis and insufficiency
I08.0 - I08.3 Rheumatic disorders of both mitral and aortic valves - Combined rheumatic disorders of mitral, aortic and tricuspid valves
I08.8 Other rheumatic multiple valve diseases
I09.1 Rheumatic diseases of endocardium, valve unspecified
I09.89 Other specified rheumatic heart diseases
I11.0 Hypertensive heart disease with heart failure
I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
I20.0 Unstable angina
I20.1 Angina pectoris with documented spasm
I20.8 Other forms of angina pectoris
I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery
I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery
I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
I21.29 ST elevation (STEMI) myocardial infarction involving other sites
I21.3 ST elevation (STEMI) myocardial infarction of unspecified site
I21.4 Non-ST elevation (NSTEMI) myocardial infarction
I22.0 - I22.2 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall - Subsequent non-ST elevation (NSTEMI) myocardial infarction
I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites
I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
I23.1 Atrial septal defect as current complication following acute myocardial infarction
I23.2 Ventricular septal defect as current complication following acute myocardial infarction
I23.4 Rupture of chordae tendineae as current complication following acute myocardial infarction
I23.5 Rupture of papillary muscle as current complication following acute myocardial infarction
I24.0 Acute coronary thrombosis not resulting in myocardial infarction
I24.8 Other forms of acute ischemic heart disease
I24.9 Acute ischemic heart disease, unspecified
I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris
I25.2 Old myocardial infarction
I25.3 Aneurysm of heart
I25.41 Coronary artery aneurysm
I25.42 Coronary artery dissection
I25.5 Ischemic cardiomyopathy
I25.6 Silent myocardial ischemia
I25.701 Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm
I25.708 - I25.711 Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris - Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.718 - I25.721 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris - Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.728 - I25.731 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris - Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
I25.739 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris
I25.750 Atherosclerosis of native coronary artery of transplanted heart with unstable angina
I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
I25.759 Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris
I25.760 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
I25.769 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris
I25.790 Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
I25.799 Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectoris
I25.810 - I25.812 Atherosclerosis of coronary artery bypass graft(s) without angina pectoris - Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris
I25.82 - I25.84 Chronic total occlusion of coronary artery - Coronary atherosclerosis due to calcified coronary lesion
I25.9 Chronic ischemic heart disease, unspecified
I26.01 Septic pulmonary embolism with acute cor pulmonale
I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
I26.09 Other pulmonary embolism with acute cor pulmonale
I26.90 Septic pulmonary embolism without acute cor pulmonale
I26.92 Saddle embolus of pulmonary artery without acute cor pulmonale
I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale
I26.94 Multiple subsegmental pulmonary emboli without acute cor pulmonale
I26.99 Other pulmonary embolism without acute cor pulmonale
I27.0 Primary pulmonary hypertension
I27.1 Kyphoscoliotic heart disease
I27.20 Pulmonary hypertension, unspecified
I27.21 Secondary pulmonary arterial hypertension
I27.22 Pulmonary hypertension due to left heart disease
I27.23 Pulmonary hypertension due to lung diseases and hypoxia
I27.24 Chronic thromboembolic pulmonary hypertension
I27.29 Other secondary pulmonary hypertension
I27.81 Cor pulmonale (chronic)
I27.82 Chronic pulmonary embolism
I27.83 Eisenmenger's syndrome
I27.89 Other specified pulmonary heart diseases
I27.9 Pulmonary heart disease, unspecified
I31.0 - I31.4 Chronic adhesive pericarditis - Cardiac tamponade
I31.8 Other specified diseases of pericardium
I31.9 Disease of pericardium, unspecified
I34.0 - I34.2 Nonrheumatic mitral (valve) insufficiency - Nonrheumatic mitral (valve) stenosis
I35.0 - I35.2 Nonrheumatic aortic (valve) stenosis - Nonrheumatic aortic (valve) stenosis with insufficiency
I36.0 - I36.2 Nonrheumatic tricuspid (valve) stenosis - Nonrheumatic tricuspid (valve) stenosis with insufficiency
I37.0 - I37.2 Nonrheumatic pulmonary valve stenosis - Nonrheumatic pulmonary valve stenosis with insufficiency
I38 Endocarditis, valve unspecified
I39 Endocarditis and heart valve disorders in diseases classified elsewhere
I42.0 - I42.7 Dilated cardiomyopathy - Cardiomyopathy due to drug and external agent
I43 Cardiomyopathy in diseases classified elsewhere
I50.1 Left ventricular failure, unspecified
I50.21 - I50.23 Acute systolic (congestive) heart failure - Acute on chronic systolic (congestive) heart failure
I50.31 - I50.33 Acute diastolic (congestive) heart failure - Acute on chronic diastolic (congestive) heart failure
I50.41 - I50.43 Acute combined systolic (congestive) and diastolic (congestive) heart failure - Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.9 Heart failure, unspecified
I51.0 - I51.2 Cardiac septal defect, acquired - Rupture of papillary muscle, not elsewhere classified
I51.81 Takotsubo syndrome
I71.01 - I71.03 Dissection of thoracic aorta - Dissection of thoracoabdominal aorta
I71.1 - I71.6 Thoracic aortic aneurysm, ruptured - Thoracoabdominal aortic aneurysm, without rupture
I79.0 Aneurysm of aorta in diseases classified elsewhere
I95.2 Hypotension due to drugs
I95.81 Postprocedural hypotension
I95.89 Other hypotension
I97.0 Postcardiotomy syndrome
I97.110 Postprocedural cardiac insufficiency following cardiac surgery
I97.111 Postprocedural cardiac insufficiency following other surgery
I97.120 Postprocedural cardiac arrest following cardiac surgery
I97.121 Postprocedural cardiac arrest following other surgery
I97.130 Postprocedural heart failure following cardiac surgery
I97.131 Postprocedural heart failure following other surgery
J80 Acute respiratory distress syndrome
J81.0 Acute pulmonary edema
J95.1 - J95.3 Acute pulmonary insufficiency following thoracic surgery - Chronic pulmonary insufficiency following surgery
J95.821 Acute postprocedural respiratory failure
J95.822 Acute and chronic postprocedural respiratory failure
J96.01 Acute respiratory failure with hypoxia
J96.02 Acute respiratory failure with hypercapnia
J96.21 Acute and chronic respiratory failure with hypoxia
J96.22 Acute and chronic respiratory failure with hypercapnia
J96.91 Respiratory failure, unspecified with hypoxia
J96.92 Respiratory failure, unspecified with hypercapnia
K72.10 Chronic hepatic failure without coma
K72.11 Chronic hepatic failure with coma
K72.90 Hepatic failure, unspecified without coma
K72.91 Hepatic failure, unspecified with coma
K76.7 Hepatorenal syndrome
M32.11 Endocarditis in systemic lupus erythematosus
R57.0 Cardiogenic shock
R57.1 Hypovolemic shock
R65.21 Severe sepsis with septic shock
T39.011A Poisoning by aspirin, accidental (unintentional), initial encounter
T39.012A Poisoning by aspirin, intentional self-harm, initial encounter
T39.013A Poisoning by aspirin, assault, initial encounter
T39.091A Poisoning by salicylates, accidental (unintentional), initial encounter
T39.092A Poisoning by salicylates, intentional self-harm, initial encounter
T39.093A Poisoning by salicylates, assault, initial encounter
T39.314A Poisoning by propionic acid derivatives, undetermined, initial encounter
T40.0X1A Poisoning by opium, accidental (unintentional), initial encounter
T40.0X2A Poisoning by opium, intentional self-harm, initial encounter
T40.0X3A Poisoning by opium, assault, initial encounter
T40.1X1A Poisoning by heroin, accidental (unintentional), initial encounter
T40.1X2A Poisoning by heroin, intentional self-harm, initial encounter
T40.1X3A Poisoning by heroin, assault, initial encounter
T40.2X1A Poisoning by other opioids, accidental (unintentional), initial encounter
T40.2X2A Poisoning by other opioids, intentional self-harm, initial encounter
T40.2X3A Poisoning by other opioids, assault, initial encounter
T40.3X1A Poisoning by methadone, accidental (unintentional), initial encounter
T40.3X2A Poisoning by methadone, intentional self-harm, initial encounter
T40.3X3A Poisoning by methadone, assault, initial encounter
T40.601A Poisoning by unspecified narcotics, accidental (unintentional), initial encounter
T40.602A Poisoning by unspecified narcotics, intentional self-harm, initial encounter
T40.603A Poisoning by unspecified narcotics, assault, initial encounter
T40.604A Poisoning by unspecified narcotics, undetermined, initial encounter
T40.691A Poisoning by other narcotics, accidental (unintentional), initial encounter
T40.692A Poisoning by other narcotics, intentional self-harm, initial encounter
T40.693A Poisoning by other narcotics, assault, initial encounter
T40.694A Poisoning by other narcotics, undetermined, initial encounter
T42.71XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, accidental (unintentional), initial encounter
T42.72XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, intentional self-harm, initial encounter
T42.73XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, assault, initial encounter
T42.74XA Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, undetermined, initial encounter
T79.4XXA Traumatic shock, initial encounter
T79.5XXA Traumatic anuria, initial encounter
T80.0XXA Air embolism following infusion, transfusion and therapeutic injection, initial encounter
T81.10XA Postprocedural shock unspecified, initial encounter
T81.11XA Postprocedural cardiogenic shock, initial encounter
T81.718A Complication of other artery following a procedure, not elsewhere classified, initial encounter
T81.72XA Complication of vein following a procedure, not elsewhere classified, initial encounter
T82.817A Embolism due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.818A Embolism due to vascular prosthetic devices, implants and grafts, initial encounter
Z86.711 Personal history of pulmonary embolism
Z86.79 Personal history of other diseases of the circulatory system
Z91.89 Other specified personal risk factors, not elsewhere classified
Z98.890 Other specified postprocedural states

Group 9

(129 Codes)
Group 9 Paragraph

ICD-10-CM codes that support medical necessity for Extra-Cardiac Angiography CPT codes: 75625, 75630, 75635, 75705, 75710, 75716, 36120, 36140, 36200, 36215, 36216, 36217, 36218, 36221, 36222, 36223, 36224, 36225, 36226, 36227, 36228, 36245, 36246, 36247, or 36248 performed during the same encounter

Group 9 Codes
CodeDescription
G45.8 Other transient cerebral ischemic attacks and related syndromes
G45.9 Transient cerebral ischemic attack, unspecified
I10 Essential (primary) hypertension
I11.0 Hypertensive heart disease with heart failure
I11.9 Hypertensive heart disease without heart failure
I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.10 Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
I15.0 Renovascular hypertension
I15.1 Hypertension secondary to other renal disorders
I63.031 Cerebral infarction due to thrombosis of right carotid artery
I63.032 Cerebral infarction due to thrombosis of left carotid artery
I63.131 Cerebral infarction due to embolism of right carotid artery
I63.132 Cerebral infarction due to embolism of left carotid artery
I63.231 Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries
I63.232 Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries
I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery
I65.21 Occlusion and stenosis of right carotid artery
I65.22 Occlusion and stenosis of left carotid artery
I65.23 Occlusion and stenosis of bilateral carotid arteries
I65.8 Occlusion and stenosis of other precerebral arteries
I67.0 Dissection of cerebral arteries, nonruptured
I67.841 Reversible cerebrovascular vasoconstriction syndrome
I67.848 Other cerebrovascular vasospasm and vasoconstriction
I67.850 Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
I67.858 Other hereditary cerebrovascular disease
I70.0 Atherosclerosis of aorta
I70.1 Atherosclerosis of renal artery
I70.211 - I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg - Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.221 - I70.223 Atherosclerosis of native arteries of extremities with rest pain, right leg - Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.231 - I70.234 Atherosclerosis of native arteries of right leg with ulceration of thigh - Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.241 - I70.244 Atherosclerosis of native arteries of left leg with ulceration of thigh - Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.25 Atherosclerosis of native arteries of other extremities with ulceration
I70.261 - I70.263 Atherosclerosis of native arteries of extremities with gangrene, right leg - Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I70.411 - I70.413 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, right leg - Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.421 - I70.423 Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, right leg - Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, bilateral legs
I70.431 - I70.434 Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of thigh - Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.441 - I70.444 Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of thigh - Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.45 Atherosclerosis of autologous vein bypass graft(s) of other extremity with ulceration
I70.461 - I70.463 Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, right leg - Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, bilateral legs
I70.511 - I70.513 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, right leg - Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.521 - I70.523 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, right leg - Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.531 - I70.534 Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of thigh - Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.541 - I70.544 Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of thigh - Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.55 Atherosclerosis of nonautologous biological bypass graft(s) of other extremity with ulceration
I70.561 - I70.563 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, right leg - Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.591 - I70.593 Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, right leg - Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, bilateral legs
I71.01 - I71.03 Dissection of thoracic aorta - Dissection of thoracoabdominal aorta
I71.1 - I71.6 Thoracic aortic aneurysm, ruptured - Thoracoabdominal aortic aneurysm, without rupture
I72.0 - I72.4 Aneurysm of carotid artery - Aneurysm of artery of lower extremity
I73.1 Thromboangiitis obliterans [Buerger's disease]
I74.01 Saddle embolus of abdominal aorta
I74.09 Other arterial embolism and thrombosis of abdominal aorta
I74.10 Embolism and thrombosis of unspecified parts of aorta
I74.11 Embolism and thrombosis of thoracic aorta
I74.19 Embolism and thrombosis of other parts of aorta
I74.2 Embolism and thrombosis of arteries of the upper extremities
I74.3 Embolism and thrombosis of arteries of the lower extremities
I74.5 Embolism and thrombosis of iliac artery
I74.8 Embolism and thrombosis of other arteries
I75.011 - I75.013 Atheroembolism of right upper extremity - Atheroembolism of bilateral upper extremities
I75.021 - I75.023 Atheroembolism of right lower extremity - Atheroembolism of bilateral lower extremities
I75.81 Atheroembolism of kidney
I75.89 Atheroembolism of other site
I77.3 Arterial fibromuscular dysplasia
I77.71 - I77.74 Dissection of carotid artery - Dissection of vertebral artery
I77.79 Dissection of other specified artery
I79.0 Aneurysm of aorta in diseases classified elsewhere
M31.4 Aortic arch syndrome [Takayasu]
N26.2 Page kidney

Group 10

(13 Codes)
Group 10 Paragraph

ICD-10-CM codes that support medical necessity for Extra-Cardiac Angiography (Non-Selective) CPT code: G0278 (Lower Extremity)

Group 10 Codes
CodeDescription
I70.211 - I70.213 Atherosclerosis of native arteries of extremities with intermittent claudication, right leg - Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.221 - I70.223 Atherosclerosis of native arteries of extremities with rest pain, right leg - Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.261 - I70.263 Atherosclerosis of native arteries of extremities with gangrene, right leg - Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I72.3 Aneurysm of iliac artery
I74.3 Embolism and thrombosis of arteries of the lower extremities
I74.5 Embolism and thrombosis of iliac artery
I77.72 Dissection of iliac artery

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

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. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

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. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Revenue codes only apply to providers who bill these services to the Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.

 

All revenue codes billed on the inpatient claim for the dates of service in question may be subject to review.


CodeDescription
0321 Radiology - Diagnostic - Angiocardiography
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
0520 Freestanding Clinic - General Classification

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2022 R10

Revision Effective: 1/1/2022
Revision Explanation: Corrected group 4 paragraph typo for 93593 and add 93595 and 93598 that were left off in error.

01/01/2022 R9

Revision Effective: 1/1/2022
Revision Explanation: Corrected group 4 paragraph under ICD-10 section to show new codes 93593, 93594, 93595, 93596, 93597 that replaced 93530, 93531, 93532, 93533.

01/01/2022 R8

Revision Effective: 1/1/2022
Revision Explanation: Annual ICD-10 Review. Removed the following codes 93530, 93531, 93532, 93533, 93561, 93562 and replaced with the following codes: 93593, 93594, 93595, 93596, 93597, and 93598.

10/21/2021 R7

Revision Effective: 10/21/2021
Revision Explanation: Annual review, no changes.

10/01/2020 R6

Revision Effective: N/A
Revision Explanation: Annual review, no changes.

10/01/2020 R5

Revision Effective: 10/01/2020
Revision Explanation: During annual ICD-10 review codes G11.1, T40.4X1A, T40.4X2A, T40.4X3A, and T40.4X4A was replaced witht he following codes: G11.10, G11.11, T40.491A, T40.492a, T40.493a, and T40.494A.

11/21/2019 R4

Revision Effective: 11/21/2019

Revision Explanation: For group 9 under ICD-10 range 75625-75724 range was corrected as 75724 is no longer an active code. Listed out the codes that are related to the group.

11/07/2019 R3

Revision Effective: 11/07/2019

Revision Explanation:Updated article text with other comments from Coverage Indications, Limitations and/or Medical Necessity and Associated Information based on TDL 190550. Added details from LCD L33959.

10/01/2019 R2

R2

Revision Effective: 10/01/2019

Revision Explanation: New codes I26.93 and I26.94 were added to ICD-10 groups 1, 5, and 8 during the annual ICD-10 update.

09/19/2019 R1

R1

Revision Effective: 09/19/2019

Revision Explanation: Converted article into new Billing and Coding template no other changes made.

Associated Documents

Related National Coverage Documents
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
01/04/2023 10/01/2022 - N/A Currently in Effect View
12/15/2022 10/01/2022 - N/A Superseded View
11/23/2022 10/01/2022 - N/A Superseded View
10/21/2022 10/01/2022 - N/A Superseded View
02/01/2022 01/01/2022 - 09/30/2022 Superseded You are here
01/10/2022 01/01/2022 - N/A Superseded View
12/14/2021 01/01/2022 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

N/A