Catheter placement in left heart for congenital anomalies, including intraprocedural injection(s) for left ventriculography, when performed; imaging supervision and interpretation
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Cardiac catheterization billed as complete when limited study performed or combined with intervention
Common93458 (cardiac catheterization complete, left heart with coronary angiography) requires documentation of: LV ventriculography, hemodynamic measurements, and complete coronary angiography (all major vessels imaged). Denied when coronary-only study (no LV gram), when billed with PCI same session without modifier 59, or when diagnostic study incomplete.
Common Causes
- • Coronary angiography performed but no LV ventriculography - bill 93454 (coronary only), not 93458
- • Hemodynamic measurements not documented - need pressures (Ao, LV, LVEDP)
- • Billed 93458 + 92928 (PCI) same session - 93458 bundled unless separate diagnostic decision made
Resolution Strategy
Document complete study: 'Left heart catheterization: Arterial access via right radial artery. Hemodynamics: Ao 110/70 mmHg, LVEDP 12 mmHg. LV ventriculography: normal size, EF 55%, no wall motion abnormalities. Coronary angiography: RCA dominant, no significant disease. Left main normal. LAD 85% stenosis proximal segment. LCx mild irregularities, no significant stenosis.' If PCI performed same session, add modifier 59 to 93458 only if diagnostic study revealed unexpected findings leading to intervention decision. If known disease undergoing planned PCI, cannot bill separate diagnostic code. If no LV gram performed, bill 93454 instead. Cannot appeal 93458 without documented complete study including LV ventriculography.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For left heart catheterization for congenital cardiac anomalies
Common Scenarios
Documentation Requirements
- Indication for cardiac catheterization
- Congenital anomaly findings
- Left ventricular function assessment
- Left ventriculography findings
- Interpretation and report
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes left heart catheterization
- Includes left ventriculography
- Includes imaging supervision and interpretation
- Right heart catheterization coded separately
- Coronary angiography coded separately
Exclusions
- 93454 (coronary angiography)
- 93455 (coronary angiography + left ventriculography)
- 93459 (left heart + ventriculography, congenital)
- 93460 (right heart catheterization for congenital anomalies)
Coding Notes
Clinical scenarios
- Indication for cardiac catheterization
- Congenital anomaly findings
- Left ventricular function assessment
- Indication for cardiac catheterization
- Congenital anomaly findings
- Left ventricular function assessment
- Indication for cardiac catheterization
- Congenital anomaly findings
- Left ventricular function assessment
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 93458 is the billing code for "Catheter placement in left heart for congenital anomalies, including intraprocedural injection(s) for left ventriculography, when performed; imaging supervision and interpretation". For left heart catheterization for congenital cardiac anomalies
Medicare pays approximately $962.96 for CPT 93458 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 93458 has a total RVU of 23.40, broken down as: Work RVU 9.00, Practice Expense RVU 13.50, and Malpractice RVU 0.90. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 93458 is "Cardiac catheterization billed as complete when limited study performed or combined with intervention". 93458 (cardiac catheterization complete, left heart with coronary angiography) requires documentation of: LV ventriculography, hemodynamic measurements, and complete coronary angiography (all major vessels imaged). Denied when coronary-only study (no LV gram), when billed with PCI same session without modifier 59, or when diagnostic study incomplete. Common causes include: Coronary angiography performed but no LV ventriculography - bill 93454 (coronary only), not 93458; Hemodynamic measurements not documented - need pressures (Ao, LV, LVEDP). Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 93458 include: Indication for cardiac catheterization; Congenital anomaly findings; Left ventricular function assessment; Left ventriculography findings. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 93458: Includes left heart catheterization. Includes left ventriculography Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 93458 include: 26 (Professional component only (interpretation)), TC (Technical component only (equipment/staff)), 59 (Distinct procedural service if performed separately). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 93458 is 45-75 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.