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Physician-side billing for the lab

Cath lab billing: diagnostic cath, PCI, ablation

Cath lab billing means getting paid for the professional work your cardiologist does in the hospital lab. Diagnostic caths go out with modifier 26, and PCI and ablation codes have no 26 split. The hospital bills the facility side.

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Cath lab billing: a cardiologist at the table in a hospital cath lab, an angiogram on the monitors
93458-26 left heart cathHospital cath · POS 22Paid
Your lab work, billed under your group
01Coding

Diagnostic cath and PCI

Your diagnostic cath is 1 code for the chambers and vessels studied. 93458 is a left heart cath with coronary angiography, and 93460 adds the right heart.

PCI is 92920 to 92944, billed per major artery with an artery modifier. 92928 is a stent in 1 artery.

A cath before a PCI in the same session pays only when it drove the decision. That means no prior cath, an inadequate prior study, or a changed condition. It needs XU or 59 and a note saying which, or it bundles into the PCI.

Coded from the cath report
CMS-1500 · Claim 10462Cath and PCI · POS 22
DOSPOSCPTModDx09/16/26229345826 XUA09/16/262292928LDA
Claim statusPaid
Diagnostic cath paid beside the stent
02Ablation and EP

Ablation and EP studies

93653 is SVT ablation, 93654 is VT, and 93656 is AF by pulmonary vein isolation. Each includes the EP study and, as of 2022, 3D mapping, so 93613 denies beside them.

Intracardiac echo, 93662, adds on to 93653 and 93654, with 26. With 93656 it is included, so it denies there.

Pacemaker and ICD implants carry a 90-day global, so related visits inside it are not billed apart.

Add-ons checked against the primary
Claims 10591, 10592Ablation · hospital outpatient
SVT · POS 22Claim 10591

93653, 93662-26

Ablation, with intracardiac echo added on

Claim statusPaid
AF · POS 22Claim 10592

93656

Intracardiac echo included, not billed

Claim statusPaid
ICE is included in AF ablation
03Denials

Modifiers 26, 59 and XU

Modifier 26 marks your professional component on each diagnostic cath code. Without it, the claim is rejected, or paid as global and taken back.

59 or XU says a service was distinct from another that day.

5 things commonly deny your cath and EP claims:

  • BundlingA cath before a PCI, sent without XU or 59.
  • Stacking93451 and 93458 billed instead of 93460.
  • ComponentA diagnostic cath code sent without 26.
  • Add-ons93613 or 93662 with an ablation that includes them.
  • AuthorizationAn elective PCI or ablation with no prior auth number.

We check all 5 on every cath lab claim before it goes out. When a denial comes back, we appeal it with your cath report.

Denials and appeals
Worked, not parked
Claim 10604Cath and PCI 92928 · POS 22
  1. DeniedCath bundled into the PCI
  2. AppealedWith XU and the note: no prior cath
  3. Paid93458-26-XU, beside the PCI
A bundled cath, worked to paid
04Codes

Cath and EP CPT codes we bill

Each code pays only when your signed report supports it.

CodeWhat it covers
93451 to 93461Diagnostic cath: right, left, coronary, grafts
93571, 92978FFR, IVUS or OCT add-ons
92920 to 92944PCI: angioplasty, atherectomy, stent, acute MI, CTO
93619, 93620EP study, without and with induction
93653, 93654, 93656Ablation: SVT, VT, AF
93655, 93657, 93662Ablation add-ons and intracardiac echo
33206 to 33208, 33249, 33274, 33270Pacemaker and ICD implants
92960Elective cardioversion
05Get in touch

Send your last 90 days of cath and EP claims

We show you which diagnostic caths were bundled into the PCI, and which went out without 26. Free, no strings.

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Free, no strings
Your 90-day cath and EP reviewLast 90 days
  • Diagnostic caths: 26 on eachIncluded
  • Caths bundled into the PCIIncluded
  • Denied, and whyIncluded