Ask Dr. Z

We have been billing code 93454 with 93505 when doing coronary angiography with endomyocardial biopsy based documentation. Our physician has stated that a LHC (93458) is medically necessary on OHT patients, as an elevated LVEDP can be a clue for microvascular coronary disease or diastolic dysfunction that is not apparent on coronary angiography. When one physician lacked the documentation of the LVEDP, he stated, “The LHC is standard for transplant surveillance, as the LVEDP gives us very important information, as well as with our congenital patients it is important to look for gradients at the aortic anastomosis. The LHC is not a means of getting to the coronaries as we use a separate catheter to perform this. A LHC is standard of care for transplant patients in pediatrics for surveillance caths. I don’t think this needs to be documented separately in the note.” Are we correct in asking for documentation of LVEDP to support the medical necessity for billing the LHC with an endomyocardial biopsy? Or is the physician correct that we can bill the 93458 with 93505?