Heart / Cardiac Catheterization Coding Left/Right

Right Heart Catheterization

This is the introduction of a catheter(s) into the right atrium, right ventricle and pulmonary artery. It includes hemodynamic measurements, cardiac output determination, shunt determinations, blood sampling, and hydrogen arrival time, as part of the procedure. 

Placement of catheter(s), repositioning, and replacement with other catheters are included as part of the procedure. Cannulation of the coronary sinus is included in this procedure.

Indications for Right Heart Catheterization

Right heart catheterization is indicated to evaluate:

• Valvular heart disease

• Congestive heart failure

• Congenital heart disease

• Cor pulmonale

• Pulmonary hypertension

• Intracardiac shunts

Limitations for Right Heart Catheterization

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.

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. 

Right heart catheterization with hemodynamic measurements done at the same time as these above-mentioned procedures will still have to meet the requirements of medical necessity.

There is no additional reimbursement for leaving a catheter in place for monitoring at the conclusion of a right heart catheterization or for the introduction of a Swan-Ganz type catheter at the time of a right heart catheterization, or for its subsequent removal.

Right heart catheterization is not indicated for:

• Atherosclerotic heart disease without heart failure

• Angioplasty or other interventional procedures

Swan-Ganz Catheterization

This procedure commonly includes insertion of a flexible, balloon-tipped catheter into the pulmonary artery for hemodynamic monitoring of the critically ill patient. 

Although Swan-Ganz catheterization is considered an invasive procedure, it may be safely performed at the bedside in an intensive care unit setting, using continuous EKG and blood pressure monitoring. In brief, this technique involves cannulation of a large vein, such as the subclavian or internal jugular vein. 

A flow-directed catheter is advanced through the central venous system into the right atrium (RA), right ventricle (RV), and pulmonary artery (PA). If desired, the catheter may be further "wedged" briefly into a small pulmonary artery branch. 

Direct pressure measurements are obtained in the respective cardiac chambers and pulmonary artery. An indirect measurement of left atrial filling pressure is obtained when the catheter is "wedged". In addition, other hemodynamic parameters may be easily measured, such as the cardiac output, systemic vascular resistance (SVR), mixed venous oxygen saturation, and intrapulmonary shunt fraction.

Indications for Swan-Ganz Catheterization

Swan-Ganz catheterization is indicated in the following situations:

• Acute myocardial infarction with hemodynamic instability

• Severe hypotension of unknown etiology, especially if the response to initial therapy is inadequate (e.g., volume loading)

• Selected cases of septic shock

• Adult respiratory distress syndrome, to confirm the diagnosis of noncardiogenic pulmonary edema (normal "wedge" pressure) and to aid in subsequent fluid and ventilator management

• Suspected cases of cardiac tamponade, to confirm the diagnosis, monitor hemodynamics during pericardiocentesis, and follow response to therapy

• Suspected papillary muscle rupture

• Possible ventricular septal defect or atrial septal defect following myocardial infarction

• Congestive heart failure responding poorly to diuretics, especially when intravascular volume status is uncertain

• Intraoperative monitoring of patients undergoing open heart surgery, particularly coronary artery bypass procedures involving multiple vessels; patients undergoing abdominal aortic aneurysm repair may also benefit from PA catheterization perioperatively 

• Drug overdose, especially when the risk of acute lung damage is high (e.g., heroin, aspirin)

• Exacerbations of chronic obstructive lung disease requiring intubation; hemodynamic monitoring may detect occult or superimposed causes of respiratory failure not suspected clinically (e.g., left ventricular dysfunction)

• End-stage liver failure with deteriorating renal function

• Suspected cases of pulmonary hypertension

•Intraoperative and hemodynamic perioperative monitoring of patients with significant heart disease, undergoing non-cardiac surgery

In general, Swan-Ganz catheterization is indicated when measurement of right atrial, pulmonary artery, and pulmonary artery occlusive pressures will significantly alter patient management.

Limitations for Swan-Ganz Catheterization

This procedure is done at the bedside in the critical care unit or the operating room.

There is no additional reimbursement for a Swan-Ganz 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. 

Swan-Ganz catheterization with hemodynamic measurements done at the same time as these above-mentioned procedures will still have to meet the requirements of medical necessity.

There is no additional reimbursement to leave a catheter in place for monitoring at the conclusion of Swan-Ganz catheterization.

Swan-Ganz catheterization is not indicated for:

• Atherosclerotic heart disease without heart failure

• Angioplasty or other interventional procedures

Left Heart Catheterization

Indications and Limitations for Left Heart Catheterization

This is the introduction of catheter(s) into the aorta, left ventricle and left atrium and includes cannulation of the coronary arteries and bypass grafts. It includes hemodynamic measurements, blood sampling and shunt determinations as part of the procedure. 

Placement of multiple catheters and their repositioning or replacement is included in this procedure. Injection procedures for selective opacification of arteries and conduits are separately reimbursable.

There is no additional reimbursement for a left heart catheterization done for reasons other than hemodynamic evaluation or angiography. Therefore, left heart catheterization is not separately reimbursed with studies such as electrophysiologic or pacing studies, or endomyocardial biopsies (unless there is medical necessity).