Ask Dr. Z

It is my understanding that certain cardiac conditions, such as ASD and VSD, can technically be congenital or acquired. The ICD-10-CM classification assumes these conditions to be congenital (when not otherwise specified, of course). The CPT codebook does not include ASD and VSD in its list of diseases for which only the non-congenital cath codes may be assigned. When a patient with a known ASD or VSD undergoes a cardiac cath, and the physician has not indicated whether the disease is congenital or acquired, can we automatically code from the congenital family of cath CPTs? Do we need to query the physician? (All of our cath lab patients are adults.)