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The procedure described by CPT® Code 93460 involves the placement of a catheter in the coronary arteries for the purpose of conducting coronary angiography. This procedure is comprehensive, as it includes intraprocedural injections necessary for the angiography, as well as the imaging supervision and interpretation required to assess the coronary arteries. Additionally, this code encompasses right and left heart catheterization, which also involves intraprocedural injections for left ventriculography when performed. The process begins with the preparation of the patient, including cleansing the skin over the arterial access site and administering a local anesthetic to minimize discomfort. Following this, a needle is used to puncture the artery, and a sheath is placed to facilitate the insertion of a guidewire. The guidewire is carefully navigated through the arterial system into the coronary arteries or bypass grafts, allowing for the subsequent placement of a catheter. Once the catheter is in position, contrast media is injected to visualize the coronary arteries and any bypass grafts, enabling the acquisition of angiograms. The procedure also includes right heart catheterization, typically accessed via the right femoral vein, and left heart catheterization, which is often performed through the same access point as the coronary arteries. This thorough examination allows for the assessment of heart chambers, valve function, and pressure measurements, culminating in a detailed report of the findings.
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The procedure described by CPT® Code 93460 is indicated for various cardiovascular assessments and evaluations. The following conditions may warrant the performance of this procedure:
The procedure begins with the preparation of the patient, which includes cleansing the skin over the arterial access site and administering a local anesthetic to minimize discomfort. Following this, a needle is used to puncture the artery, and a sheath is placed to facilitate the insertion of a guidewire. The guidewire is carefully navigated through the artery into the aorta and positioned in the right or left coronary artery, or an arterial or venous coronary bypass graft. Once the guidewire is in place, a catheter is threaded over it, and the guidewire is subsequently removed. Contrast media is then injected through the catheter, allowing for visualization of the coronary arteries and bypass grafts, and angiograms are obtained to assess their condition.
In conjunction with the coronary angiography, right heart catheterization is performed. This typically involves accessing the right femoral vein in the groin, where a small stab incision is made, and a needle is inserted into the blood vessel, followed by the placement of a sheath. A guidewire is then threaded through the femoral vein, external iliac vein, inferior vena cava, and into the right atrium, after which a catheter is advanced over the guidewire. Once positioned, the guidewire is withdrawn, and the catheter is passed through the right side of the heart into the pulmonary arteries. During this phase, the right heart chambers are inspected, pressures are obtained, and oxygen levels are measured. The tricuspid and pulmonary valves are also evaluated, and pressure gradients are assessed. If necessary, a separately reportable angiogram of the right heart and/or pulmonary arteries may be obtained.
Following the right heart catheterization, the left heart catheterization is performed. This is typically accessed via the same vessel used for the coronary arteries and/or bypass grafts. The catheter is advanced into the left ventricle, allowing for inspection of the aortic valve, left ventricle, mitral valve, and left atrium. Left ventricular and atrial pressures are obtained, along with pressure gradients across the aortic and mitral valves. Contrast is injected as needed, and a left ventriculogram is obtained. Additionally, a separately reportable angiogram of the aorta may be performed. Upon completion of the procedure, the catheters are withdrawn, and pressure is applied to the venous and arterial puncture sites, followed by the application of compression dressings to ensure hemostasis.
After the completion of the procedure, patients are typically monitored for any complications or adverse effects. The puncture sites are assessed for bleeding, and pressure is maintained to prevent hematoma formation. Compression dressings are applied to the access sites to ensure proper healing. Patients may be advised to rest and limit physical activity for a specified period to promote recovery. The results of the coronary artery and bypass graft studies, as well as the right and left heart catheterization and ventriculogram, are reviewed, and a comprehensive written report of the findings is generated for further evaluation and management by the healthcare provider.
| Short Descr | R&L HRT ART/VENTRICLE ANGIO | Medium Descr | R & L HRT CATH WINJX HRT ART& L VENTR IMG | Long Descr | 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 | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P2F - Major procedure, cardiovascular-Other | MUE | 1 | CCS Clinical Classification | 47 - Diagnostic cardiac catheterization, coronary arteriography |
This is a primary code that can be used with these additional add-on codes.
| 0523T | Add-on Code Resequenced Code MPFS Status: Carrier Priced APC N ASC N1 Intraprocedural coronary fractional flow reserve (FFR) with 3D functional mapping of color-coded FFR values for the coronary tree, derived from coronary angiogram data, for real-time review and interpretation of possible atherosclerotic stenosis(es) intervention (List separately in addition to code for primary procedure) | 92973 | Addon Code Resequenced Code MPFS Status: Active Code APC N CPT Assistant Article Illustration for Code Percutaneous transluminal coronary thrombectomy mechanical (List separately in addition to code for primary procedure) | 92974 | Addon Code Resequenced Code MPFS Status: Active Code APC N CPT Assistant Article Illustration for Code Transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy (List separately in addition to code for primary procedure) | 92978 | Addon Code CPT Resequenced MPFS Status: Carrier Priced APC N ASC N1 CPT Assistant Article Illustration for Code 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) | 93462 | Addon Code MPFS Status: Active Code APC N ASC N1 Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure) | 93463 | Addon Code MPFS Status: Active Code APC N 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 | Addon Code MPFS Status: Active Code APC N Physiologic exercise study (eg, bicycle or arm ergometry) including assessing hemodynamic measurements before and after (List separately in addition to code for primary procedure) | 93566 | Addon Code MPFS Status: Active Code APC N ASC N1 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 | Addon Code MPFS Status: Active Code APC N ASC N1 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for supravalvular aortography (List separately in addition to code for primary procedure) | 93568 | Addon Code MPFS Status: Active Code APC N ASC N1 Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for nonselective pulmonary arterial angiography (List separately in addition to code for primary procedure) | 93569 | Add-on Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, unilateral (List separately in addition to code for primary procedure) | 93571 | Addon Code MPFS Status: Carrier Priced APC N ASC N1 CPT Assistant Article 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) | 93573 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, bilateral (List separately in addition to code for primary procedure) | 93574 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary venous angiography of each distinct pulmonary vein during cardiac catheterization (List separately in addition to code for primary procedure) | 93575 | Add-on Code Resequenced Code MPFS Status: Active Code APC N Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary angiography of major aortopulmonary collateral arteries (MAPCAs) arising off the aorta or its systemic branches, during cardiac catheterization for congenital heart defects, each distinct vessel (List separately in addition to code for primary procedure) | 93662 | Addon Code MPFS Status: Carrier Priced APC N PUB 100 CPT Assistant Article Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (List separately in addition to code for primary procedure) | G0278 | Add-on Code Medicare Coverage: Carrier Priced MPFS Status: Active Code APC N 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) |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GC | This service has been performed in part by a resident under the direction of a teaching physician | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | AO | Alternate payment method declined by provider of service | CR | Catastrophe/disaster related | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | LM | Left main coronary artery | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 23 | Unusual anesthesia: occasionally, a procedure, which usually requires either no anesthesia or local anesthesia, because of unusual circumstances must be done under general anesthesia. this circumstance may be reported by adding modifier 23 to the procedure code of the basic service. | 24 | Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period: the physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. this circumstance may be reported by adding modifier 24 to the appropriate level of e/m service. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 57 | Decision for surgery: an evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of e/m service. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 81 | Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. | AI | Principal physician of record | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CA | Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | ET | Emergency services | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | KX | Requirements specified in the medical policy have been met | LD | Left anterior descending coronary artery | LT | Left side (used to identify procedures performed on the left side of the body) | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RC | Right coronary artery | RI | Ramus intermedius coronary artery | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2011-01-01 | Added | Added |
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