Cardiology Question for the Week of March 6, 2017

Question:

The patient presents for a diagnostic left heart catheterization (LHC), left ventriculogram and selective coronary angiography. The physician determines that hemodynamic assessment should be performed before and after exercise to assist in the clinical diagnosis. The patient is given a pair of 2.5-pound dumbbell weights then asked to exercise by extending the arms and bringing the arms with the weights to their chest. The patient exercises for three to five minutes. Does this type of exercise meet the criteria for billing code 93464?

Answer:

Note that the descriptor for code 93464 lists bicycle or arm ergometry as examples for the type of exercise used in the study:

The descriptor does not limit it to only these types of physiologic stress. Therefore, the exercise may be physical or a pharmacologic agent may be used instead of exercise. When a pharmacologic agent is administered over time, it will be titrated to a level that achieves the desired heart rate, hemodynamic response, or limiting symptoms.