Description

Cardiac catheterization is an invasive procedure that is used to diagnose certain cardiovascular conditions. A catheter (thin, hollow tube) is inserted into the body through a blood vessel in the arm, groin or neck, then guided to the heart. Pumping ability, pressure and oxygen content in the aorta, pulmonary artery and cardiac chambers (left and right atria, left and right ventricles) may be measured. X-ray images of the coronary arteries, valves and heart chambers are taken after an injection of contrast dye has been administered to allow visualization. The heart valves (aortic, mitral, pulmonary and tricuspid) may be evaluated for leakage or narrowing that decreases heart function.

Cardiac catheterization includes, but may not be limited to, the following specific procedures:

• Coronary angiography (angiogram) – A catheter is inserted from an artery in the arm, groin or wrist and into one or more of the coronary arteries to obtain x-ray images using an injection of contrast dye. The images may reveal a narrowing or blockage that reduces blood flow.
• Coronary aortography – X-ray images are obtained of the aorta and its branches to detect abnormalities.
• Graft angiography – X-ray images are obtained of surgically created coronary artery bypass grafts to evaluate graft patency.
• Intravascular (endoluminal) imaging is used to allow visualization of coronary vessel or graft lesions during a diagnostic or therapeutic cardiac catheterization procedure in order to guide treatment decisions. Techniques include, but may not be limited to:
  1. Intravascular ultrasound (IVUS) allows visualization of the coronary artery wall by utilizing ultrasound to delineate plaque morphology and distribution and to provide guidance for transcatheter coronary intervention.
  2. Optical coherence tomography (OCT) relies on the reflection of light to obtain cross-sectional detailed images of the coronary artery to characterize the structure and extent of atherosclerosis and assess acute stent placement.
• Left heart catheterization – A catheter is inserted into an artery in the arm, groin or wrist and guided to the left ventricle of the heart to measure pressures or to obtain an angiogram. This procedure is most commonly used to assess coronary anatomy and the presence of coronary artery disease, left ventricular pressure and function and valvular heart disease.

Right heart catheterization – A catheter is inserted into an artery in the arm, groin or wrist
or neck and guided to the right-sided heart chambers (right atrium, right ventricle) and the pulmonary artery. Pressures and blood oxygen saturations are measured in the chambers, and angiogram images of the right ventricle and pulmonary artery may be obtained. This procedure is often performed as a diagnostic test to evaluate heart failure, valvular heart disease and congenital heart disease.

Cardiac Catheterization Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 03/01/2023
Policy Number: HUM-0580-006
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• Trans-septal catheterization – A catheter enters the left atrium from the right atrium by puncturing through the septum (wall between the left and right atrium) to measure pressures or obtain angiogram images of the left atrium or left ventricle.

If abnormalities (eg, vessel blockage) are revealed during cardiac catheterization, treatment may occur immediately. Percutaneous coronary intervention (PCI) treats an arterial blockage or narrowing using several techniques during the cardiac catheterization procedure which include, but may not be limited to:

• Balloon angioplasty – A deflated balloon is threaded via a catheter through the coronary artery to the region of narrowing or blockage. The balloon is inflated to widen the blocked areas where blood flow has been reduced or cut off. A stent may then be inserted to keep the artery open and reduce the potential for recurrent blockage. For information regarding coronary stents and angioplasty, please refer to Coronary Stents and Angioplasty Medical Coverage Policy.
• Atherectomy – A rotating shaver is attached to the catheter tip to cut plaque away from the artery to restore optimal blood flow.

Other interventions that may occur during cardiac catheterization include, but may not be limited to:

• Biopsy – A sample of heart tissue or cells is removed to allow evaluation and diagnostic study.
• Transcatheter heart valve repair or replacement– A catheter-based procedure that repairs or replaces an abnormal or diseased heart valve to restore valve function. For information regarding transcatheter valve procedures, please refer to Transcatheter Valve Procedures Medical Coverage Policy.

Coverage Determination

Cardiac catheterization deemed urgent/emergent (eg, suspected acute coronary syndrome, cardiogenic shock, spontaneous coronary artery dissection) is not subject to the criteria within this medical coverage policy.

Cardiac Catheterization Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 03/01/2023
Policy Number: HUM-0580-006
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Humana members may be eligible under the Plan for cardiac catheterization for the following indications:

• Absence of contraindications; AND
• Congenital heart disease, known or suspected and ANY of the following:
  • Direct measurement of cardiac chamber pressures or oxygen saturations needed (eg, for intracardiac shunt, valvular heart disease); OR
  • Invasive cardiovascular procedure planned, and preoperative or postoperative catheterization or angiographic imaging needed (eg, for pressure or gradient measurements); OR
  • Known supravalvular aortic stenosis and coronary imaging is needed due to symptoms of coronary ischemia (eg, chest pain or anginal equivalent*, syncope, arrhythmia); OR
  • Noninvasive imaging is nondiagnostic or discordant with physical examination findings; OR
• Coronary artery disease (CAD), known or suspected, as indicated by any of the following:
  • Acute chest pain* with any of the following:
    • Worsening frequency of chest pain or anginal equivalent* and ALL of the following:
      • Intermediate risk calculated using a validated risk predictor (eg, Pretest Probability of CAD [CAD Consortium]); AND
      • Known CAD as evidenced by 1 or more of the following;
        • History of prior coronary revascularization; OR

Cardiac Catheterization Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 03/01/2023
Policy Number: HUM-0580-006
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• Prior anatomic testing (eg, coronary angiogram or coronary computed tomographic angiography [CCTA]) shows significant stenosis in the left main and/or proximal left anterior descending greater than 50% or multivessel CAD; OR
• Noninvasive stress imaging contraindicated or is nondiagnostic; OR
• Recurrent chest pain or anginal equivalent* within 9 months of PCI or coronary artery bypass graft (CABG); OR
• Evidence of high risk based on noninvasive testing, as indicated by any of the following:
  • Duke Treadmill Score less than or equal to -11; OR
  • Echocardiographic wall motion abnormality involving greater than 2 segments, developing at dobutamine dose of less than 10 mcg/kg per minute or at a heart rate less than 120 beats per minute; OR
  • Left ventricular ejection fraction 40% or less at rest; OR
  • Perfusion imaging shows evidence of global ischemia, ischemia involving multiple territories or a single large territory of myocardium at risk; OR
  • Stress electrocardiogram findings of ST-segment elevation ventricular arrhythmia, or at least 2 millimeters of ST-segment depression; OR
  • Stress-induced large perfusion defect or multiple moderate perfusion defects; OR
  • Stress-induced left ventricular dysfunction; OR
• Following myocardial infarction and during risk stratification phase at the time of initial presentation, and one or more of the following:
  • Ischemia at low level of exercise on noninvasive testing; OR
  • Left ventricular ejection fraction 45% or less, and individual is unable to undergo noninvasive testing; OR
• Prinzmetal (variant) angina, suspected; OR
• Stable chest pain* and 1 or more of the following:
  • Change in symptoms or associated precipitants and noninvasive stress imaging is contraindicated or nondiagnostic; OR
  • Negative stress test with high clinical suspicion of CAD; OR
  • Suspected obstructive CAD with lifestyle limiting stable chest pain or anginal equivalent* despite a trial of at least 12 weeks utilizing optimal guideline-directed medical therapy (GDMT)** and moderate to severe ischemia as indicated by 1 or more of the following:
    • Fractional flow reserve by computed tomography (FFRCT) less than or equal to 0.80; OR
    • Greater than or equal to 50% stenosis in the left main coronary artery, defined by CCTA; OR
    • Stenosis greater than or equal to 70% in the left main and right coronary arteries and left anterior descending artery as defined by CCTA; OR
• Cor pulmonale, at initial diagnosis or with worsening symptoms; OR
• Heart failure, as indicated by any of the following:
  • Associated with chest pain or anginal equivalent*; OR
  • Constrictive pericarditis; OR
  • Episodic heart failure with preserved ejection fraction on noninvasive testing; OR

Cardiac Catheterization Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 03/01/2023
Policy Number: HUM-0580-006
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Left ventricular ejection fraction 45% or less, and individual is unable to undergo noninvasive testing; OR

• Prinzmetal (variant) angina, suspected; OR
• Stable chest pain* and 1 or more of the following:
  • Change in symptoms or associated precipitants and noninvasive stress imaging is contraindicated or nondiagnostic; OR
  • Negative stress test with high clinical suspicion of CAD; OR
  • Suspected obstructive CAD with lifestyle limiting stable chest pain or anginal equivalent* despite a trial of at least 12 weeks utilizing optimal guideline-directed medical therapy (GDMT)** and moderate to severe ischemia as indicated by 1 or more of the following:
    • Fractional flow reserve by computed tomography (FFRCT) less than or equal to 0.80; OR
    • Greater than or equal to 50% stenosis in the left main coronary artery, defined by CCTA; OR
    • Stenosis greater than or equal to 70% in the left main and right coronary arteries and left anterior descending artery as defined by CCTA;
• Cor pulmonale, at initial diagnosis or with worsening symptoms; OR
• Heart failure, as indicated by any of the following:
  • Associated with chest pain or anginal equivalent*; OR
  • Constrictive pericarditis; OR
  • Episodic heart failure with preserved ejection fraction on noninvasive testing;

Cardiac Catheterization Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 03/01/2023
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• Left ventricular ejection fraction (LVEF) less than 45%, unexplained by noninvasive testing; OR
• Post myocardial infarction ventricular aneurysm; OR
• Post myocardial infarction when LVEF less than or equal to 35%; OR
• Preoperative planning needed before cardiac transplant or mechanical circulatory support; OR
• Restrictive cardiomyopathy; OR
• Reversible ischemia on stress echocardiogram or myocardial perfusion imaging and revascularization (eg, CABG, PCI) being considered; OR
• Wall motion abnormality involving more than 2 segments with low dose dobutamine or at heart rate less than 120 beats per minute; OR

Hypertrophic cardiomyopathy, as indicated by any of the following:

• CAD suspected, as indicated by BOTH of the following:
  • Chest pain or anginal equivalent*; AND
  • Identification of CAD will affect management; OR
• Measurement of left ventricular outflow gradient needed due to equivocal or discordant results on noninvasive testing; OR
• Septal reduction therapy planned (eg, alcohol septal ablation, surgical myectomy); OR
• Known Kawasaki disease; OR
• Pericardial tamponade; OR

Cardiac Catheterization Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 03/01/2023
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• Preoperative or preprocedural planning needed before high risk peripheral vascular surgery (eg, aneurysm repair) without known CAD if abnormal noninvasive stress test or chest pain or anginal equivalent*; OR
• Pulmonary artery extrinsic compression of left main coronary artery, as indicated by BOTH of the following:
  • Chronic pulmonary hypertension; AND
  • Ischemic heart disease, as indicated by chest pain or anginal equivalent* or abnormal left ventricular function; OR
• Pulmonary hypertension, known or suspected; OR
• Surveillance of cardiac allograft vasculopathy and acute rejection following cardiac transplant; OR
• Valvular heart disease, known or suspected, as indicated by any of the following:
  • Atrial myxoma when transesophageal echocardiography (TEE) is indeterminate; OR
  • Individual is symptomatic and echocardiographic findings are equivocal for valve disease severity; OR
  • Mild to moderate valvular heart disease, as indicated by any of the following:
    • Canadian Cardiovascular Society class II, III or IV chest pain; OR
    • Ejection fraction less than or equal to 45%; OR
    • Heart failure; OR
    • Ischemia documented by noninvasive testing; OR
  • Noninvasive test results are inconclusive, inconsistent or discordant with individual’s symptoms; OR

Cardiac Catheterization Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 03/01/2023
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• Preoperative planning needed before Ross procedure to identify coronary orifices if not identified noninvasively; OR
• Preoperative, preprocedural or intraprocedural planning needed for indicated valve surgery, transcatheter valve replacement or repair, as indicated by any of the following:
  • CAD, known or suspected (due to risk factors, symptoms or noninvasive testing); OR
  • Ejection fraction less than 55%; OR
  • Transcatheter aortic valve replacement or percutaneous mitral valve repair, and need to evaluate concomitant coronary artery disease as demonstrated by CCTA; OR
• Severe aortic or mitral regurgitation on echocardiography; AND
  • Physical examination findings discordant with echocardiographic or other noninvasive imaging findings;
  • Pulmonary hypertension; OR
• Repeat evaluation of specific area or structure with same imaging modality, as indicated by any of the following:
  • Change in clinical status (eg, worsening symptoms or new associated symptoms); OR
  • Need for interval reassessment that may impact treatment plan; OR
  • Need for re-imaging either prior to or after performance of invasive procedure.

Chest pain includes pain, pressure, tightness or discomfort in the chest, shoulders, arms, neck, back, upper abdomen or jaw, as well as shortness of breath and fatigue and should all be considered anginal equivalents.¹¹ Acute chest pain occurs when the onset is new or involves a change in pattern, intensity or duration compared with previous episodes in individuals with recurrent symptoms. Stable chest pain occurs when symptoms are chronic and associated with consistent precipitants such as exertion or emotional stress.¹¹

GDMT represents individualized optimal medical therapy and lifestyle modifications for CAD and may include antianginal, antihypertensive, antiplatelet and statin or other lipid-lowering therapies along with diet modification, physical activity and smoking cessation.²⁸

Coverage Limitations

Humana members may NOT be eligible under the Plan for cardiac catheterization for any indications other than those listed above including, but may not be limited to:

• Routine preoperative screening; OR
• Normal CCTA or coronary angiogram without stenoses or plaque within the last 2 years when symptoms are unchanged; OR
• Normal stress test (with adequate stress) within the last year when symptoms are unchanged

These are considered not medically necessary as defined in the member’s individual certificate. Please refer to the member’s individual certificate for the specific definition.

Humana members may NOT be eligible under the Plan for cardiac catheterization for any of the following contraindications:

• Allergy or intolerance to iodinated contrast material that cannot be effectively pretreated; OR
• Inability or intolerance to lay flat or at an angle that allows safe performance of the procedure; OR

Cardiac Catheterization Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 03/01/2023
Policy Number: HUM-0580-006
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• Peripheral vascular disease that prohibits peripheral access; OR
• Renal function impairment when the risk of nephrotoxicity with contrast agents outweighs the benefit of the cardiac catheterization

These are considered experimental/investigational as they are not identified as widely used and generally accepted for any other proposed uses as reported in nationally recognized peer-reviewed medical literature published in the English language.

Additional information about cardiac catheterization may be found from the following websites:

Background

• American Heart Association
• National Heart, Lung and Blood Institute
• National Library of Medicine

Medical Alternatives

Alternatives to cardiac catheterization include, but may not be limited to, the following:

• Cardiac computed tomography angiography (CCTA)

For information regarding CCTA, please refer to Coronary CT Angiography, Fractional Flow Reserve with CT, Calcium Scoring Medical Coverage Policy.

Physician consultation is advised to make an informed decision based on an individual's health needs.

Humana may offer a disease management program for this condition. The member may call the number on his/her identification card to ask about our programs to help manage his/her care.

Any CPT, HCPCS or ICD codes listed on this medical coverage policy are for informational purposes only. Do not rely on the accuracy and inclusion of specific Provider Claims Codes

Cardiac Catheterization Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 03/01/2023
Policy Number: HUM-0580-006
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Inclusion of a code does not guarantee coverage and or reimbursement for a service or procedure.

CPT® Code(s)

Description

Comments

• 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

Cardiac Catheterization Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 03/01/2023
Policy Number: HUM-0580-006
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CPT Code(s)

Description

• 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)
• 93563 - Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective coronary angiography during congenital heart catheterization

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)

Cardiac Catheterization Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 03/01/2023
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• 93564 - 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)
• 93569 - 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)
• 93573 - 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)

Cardiac Catheterization Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 03/01/2023
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• 93574 - 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 - 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)
• 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)

Cardiac Catheterization Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 03/01/2023
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CPT® Category III Code(s)

Description

Comments

No code(s) identified

HCPCS Code(s)

Description

Comments

• C7516 - Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, with endoluminal imaging of initial 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
• C7517 - Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, with 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
• C7518 - Catheter placement in coronary artery(ies) 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 with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (ivus) or optical coherence tomography (oct) during diagnostic evaluation and/or therapeutic intervention including

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Revision Date: 01/01/2024
Review Date: 03/01/2023
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• C7519 - Catheter placement in coronary artery(ies) 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 with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
• C7520 - Catheter placement in coronary artery(ies) 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) includes intraprocedural injection(s) for bypass graft angiography with 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
• C7521 - Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography with right heart catheterization with endoluminal imaging of initial 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

Cardiac Catheterization Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 03/01/2023
Policy Number: HUM-0580-006
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• C7522 - angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation with right heart catheterization, with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
• C7523 - Catheter placement in coronary artery(ies) 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, with endoluminal imaging of initial 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
• C7524 - Catheter placement in coronary artery(ies) 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, with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
• C7525 - Catheter placement in coronary artery(ies) 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 with endoluminal imaging of initial 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

Cardiac Catheterization Effective Date: 01/01/2024
Revision Date: 01/01/2024
Review Date: 03/01/2023
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• C7526 - Catheter placement in coronary artery(ies) 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 with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
• C7527 - Catheter placement in coronary artery(ies) 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, with endoluminal imaging of initial 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
• C7528 - Catheter placement in coronary artery(ies) 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, with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically

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• C7529 - Catheter placement in coronary artery(ies) 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 with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography including pharmacologically induced stress
• C7552 - 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 with intravascular doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress, initial vessel
• C7553 - 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 with 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

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• Including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial,
• New Code Effective 01/01/2024
• C7558 - venous grafts) with bypass graft angiography with 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

References

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• American Association for Thoracic Surgery (AATS). 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: surgical treatment of infective endocarditis: executive summary. https://www.aats.org. Published June 2017. Accessed January 17, 2023.
• American College of Cardiology (ACC).

• American College of Cardiology (ACC). 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. https://www.acc.org. Published January 29, 2013. Accessed January 18, 2023.
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• American College of Cardiology (ACC). 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. https://www.acc.org. Published October 2, 2018. Accessed January 18, 2023.
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• American College of Cardiology (ACC). ACC/AHA guidelines for coronary angiography: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. https://www.acc.org. Published May 1999. Accessed January 18, 2023.
• American College of Cardiology (ACC). ACCF/AHA 2009 expert consensus document on pulmonary hypertension. https://www.acc.org. Published April 28, 2009. Accessed January 18, 2023.
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• American College of Radiology (ACR). ACR Appropriateness Criteria. Chest pain – possible acute coronary syndrome. https://www.acr.org. Published 2019. Accessed January 18, 2023.
• American College of Radiology (ACR). ACR Appropriateness Criteria. Chronic chest pain – high probability of coronary artery disease. https://www.acr.org. Published 2016. Updated 2021. Accessed January 18, 2023.

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• American College of Radiology (ACR). ACR Appropriateness Criteria. Chronic chest pain, noncardiac etiology unlikely: low to intermediate probability of coronary artery disease. https://www.acr.org. Published 2018. Accessed January 18, 2023.
• American College of Radiology (ACR). ACR Appropriateness Criteria. Dyspnea – suspected cardiac origin (ischemia already excluded). https://www.acr.org. Published 2016. Updated 2021. Accessed January 8, 2023.
• American College of Radiology (ACR). ACR Appropriateness Criteria. Imaging for transcatheter aortic valve replacement. https://www.acr.org. Published 2017. Accessed January 18, 2023.
• American College of Radiology (ACR). ACR Appropriateness Criteria. Infective endocarditis. https://www.acr.org. Published 1998. Updated 2020. Accessed January 18, 2023.

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• American College of Radiology (ACR). ACR Appropriateness Criteria. Known or suspected congenital heart disease in the adult. https://www.acr.org. Published 2016. Accessed January 18, 2023.
• American College of Radiology (ACR). ACR Appropriateness Criteria. Nonischemic myocardial disease with clinical manifestations (ischemic cardiomyopathy already excluded). https://www.acr.org. Published 2013. Updated 2020. Accessed January 18, 2023.
• American College of Radiology (ACR). ACR Appropriateness Criteria. Suspected acute aortic syndrome. https://www.acr.org. Published 1995. Updated 2021. Accessed January 18, 2023.
• American College of Radiology (ACR). ACR Appropriateness Criteria. Suspected new-onset and known nonacute heart failure. https://www.acr.org. Published 2018. Accessed January 18, 2023.
• American College of Radiology (ACR). ACR Appropriateness Criteria. Suspected pulmonary embolism. https://www.acr.org. Published 2016. Accessed January 18, 2023.
• American College of Radiology (ACR). ACR-SIR-SPR practice parameter for performance of arteriography. https://www.acr.org. Published 2017. Accessed January 18, 2023.
• American Heart Association (AHA). 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. https://www.acc.org. Published November 4, 2014. Accessed January 18, 2023.
• American Heart Association (AHA). AHA/ATS Guideline. Pediatric pulmonary hypertension. https://www.heart.org. Published November 24, 2015. Accessed January 18, 2023.
• American Heart Association (AHA). AHA Scientific Statement. Congenital heart disease in the older adult. https://www.heart.org. Published May 26, 2015. Accessed January 19, 2023.

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• American Heart Association (AHA). AHA Scientific Statement. Diagnosis, treatment and long-term management of Kawasaki disease. https://www.heart.org. Published April 25, 2017. Accessed January 19, 2023.
• ClinicalKey. Guagliumi G, Raber L, Shimamura K, Akasaka T. Optical coherence tomography. Textbook of Interventional Cardiology. 8th ed. Elsevier; 2020: 1067-1093.e4. https://www.clinicalkey.com. Accessed February 7, 2023.
• ClinicalKey. Hahn RT, Cavalcante JL. Imaging the aortic valve. In: Otto CM, Bonow RO. Valvular Heart Disease: A Companion to Braunwald’s Heart Disease. 5th ed.

• ClinicalKey. Guagliumi G, Raber L, Shimamura K, Akasaka T. Optical coherence tomography. In: Topol EJ, Tierstein PS. Textbook of Interventional Cardiology. 8th ed. Elsevier; 2020: 1018-1035.e4. https://www.clinicalkey.com. Accessed February 7, 2023.
• ClinicalKey. Kern MJ, Kirtane AJ. Catheterization and angiography. In: Goldman L, Schafer AI. Goldman Cecil Medicine. 26th ed. Elsevier; 2020:270-275. https://www.clinicalkey.com. Accessed January 17, 2023.
• ClinicalKey. Kern MJ, Seto AH, Hermann J. Invasive hemodynamic diagnosis of cardiac disease. In: Libby P, Bonow RO, Mann DL, Tomasellie GF, Bhatt DL, Solomon SD. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Elsevier; 2022:385-409. https://www.clinicalkey.com. Accessed January 17, 2023.
• ClinicalKey. Lewinter, MM, Cremer PC, Klein AL. Pericardial diseases. In: Libby P, Bonow RO, Mann DL, Tomasellie GF, Bhatt DL, Solomon SD. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Elsevier; 2022:1615-1634. https://www.clinicalkey.com. Accessed January 17, 2023.
• ClinicalKey. Linefsky JP, Otto CM. Aortic stenosis: clinical presentation, disease stages, and timing of intervention. In: Otto CM, Bonow RO. Valvular Heart Disease: A Companion to Braunwald's Heart Disease. 5th ed. Elsevier; 2021:156-178.e1. https://www.clinicalkey.com. Accessed January 17, 2023.

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• ECRI Institute. Clinical Evidence Assessment. Intravascular optical coherence tomography for evaluating coronary artery disease. https://www.ecri.org. Published September 11, 2019. Accessed February 7, 2023.
• ECRI Institute. Hotline Response (ARCHIVED). Intravascular ultrasound for evaluating coronary artery disease. https://www.ecri.org. Published August 8, 2018. Accessed March 1, 2023.
• Heart Failure Society of America (HFSA). 2010 Heart Failure Guidelines. Section 11: Evaluation and management of patients with heart failure and preserved left ventricular ejection fraction. https://www.hfsa.org. Published 2010. Accessed January 19, 2023.
• Heart Failure Society of America (HFSA). 2010 Heart Failure Guidelines. Section 12: Evaluation and management of patients with acute decompensated heart failure. https://www.hfsa.org. Published 2010. Accessed January 19, 2023.
• Heart Failure Society of America (HFSA). 2010 Heart Failure Guidelines. Section 13: Evaluation and therapy for heart failure in the setting of ischemic heart disease. https://www.hfsa.org. Published 2010. Accessed January 19, 2023.
• MCG Health. Cardiac catheterization and angiography. 26th edition. https://www.mcg.com. Accessed January 17, 2023.
• Merck Manual: Professional Version. Cardiac catheterization. https://www.merckmanuals.com. Updated September 2022. Accessed January 17, 2023.
• Society of Cardiovascular Computed Tomography (SCCT). SCCT 2021 expert consensus document on coronary computed tomographic angiography. https://www.scct.org. Published November 19, 2020. Accessed January 19, 2023.

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• Society of Thoracic Surgeons (STS).

• Aortic valve and ascending aorta guidelines for management and quality measures. https://www.sts.org. Published May 2013. Accessed January 19, 2023.
• UpToDate, Inc. Approach to evaluation of the right ventricle in adults. https://www.uptodate.com. Updated December 2022. Accessed January 13, 2023.
• UpToDate, Inc. Cardiac catheterization techniques: normal hemodynamics. https://www.uptodate.com. Updated December 2022. Accessed January 13, 2023.
• UpToDate, Inc. Clinical manifestations and diagnosis of advanced heart failure. https://www.uptodate.com. Updated December 2022. Accessed January 13, 2023.
• UpToDate, Inc. Clinical manifestations and diagnosis of atrial septal defects in adults. https://www.uptodate.com. Updated December 2022. Accessed January 13, 2023.
• UpToDate, Inc. Clinical manifestations and diagnosis of surgical aortic and mitral prosthetic valve regurgitation. https://www.uptodate.com. Updated December 2022. Accessed January 13, 2023.
• UpToDate, Inc. Complications of diagnostic cardiac catheterization. https://www.uptodate.com. Updated December 2022. Accessed January 13, 2023.
• UpToDate, Inc. Hemodynamics of valvular disorders as measured by cardiac catheterization. https://www.uptodate.com. Updated December 2022. Accessed January 13, 2023.
• UpToDate, Inc. Intravascular ultrasound, optical coherence tomography and angioscopy of coronary circulation. https://www.uptodate.com. Updated January 2023. Accessed February 7, 2023.

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• UpToDate, Inc. Pulmonary hypertension associated with bronchopulmonary dysplasia. https://www.uptodate.com. Updated December 17, 2022. Accessed January 13, 2023.
• UpToDate, Inc. Therapeutic angiogenesis for management of refractory angina. https://www.uptodate.com. Updated January 2023. Accessed February 3, 2023.
• UpToDate, Inc. Thromboembolism from aortic plaque. https://www.uptodate.com. Updated December 2022. Accessed January 13, 2023.

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Appendix A

Canadian Cardiovascular Society Classification System