AHA Coding Clinic® for ICD-9 - 2008 Issue 3; Clarifications

Cardiac Resynchronization Defibrillator (CRT-D) and Coronary Sinus Mapping

Could you clarify the instructions published in Coding Clinic, First Quarter 2007, pages 16-17, regarding coronary sinus mapping performed in conjunction with cardiac resynchronization defibrillator (CRT-D) placement? Coding Clinic advised that when a coronary angiogram is performed along with CRT-D placement, the angiogram is coded since this is not an inherent part of the procedure. Does this mean that the surgeon must document whether or not the coronary sinus mapping is inherent to the procedure? The cardiologists at our facility state that a coronary sinus venogram is always done to visualize the coronary sinus prior to left ventricular (LV) lead placement whenever the device is inserted. Therefore, is the mapping inclusive with the total procedure and captured with codes 00.50, 00.51 and 00.52? Conversely, a coronary angiogram is not always performed with CRT-D placement. In addition, the index to procedures does not lead to the same code assignment for venogram (88.63) and angiogram (88.52). The index directs to code 88.63, Phlebography of other intrathoracic veins using contrast material, for venogram of coronary sinus. ...

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