Ask Dr. Z

Will you please clarify which of these instructions is the current one to go by in regard to this question posted 9/1/11: Is 93024 the appropriate code for a coronary artery spasm test using acetylcholine (acetylcholine challenge) during a heart catheterization procedure? Answer was no additional codes are reported for acetylcholine challenge tests. In AHA Coding Clinic for HCPCS Third Quarter 2009 the following coding instruction for hospital billing was given: • Do not report additional codes for performance of an acetylcholine (Ach) challenge test performed during cardiac catheterization. It is included in the cardiac catheterization procedure. Per page 505 in the Cardiac ebook: The ergonovine test - otherwise known as a "provocation test" - is not done often, but can be performed if angina is thought to be caused by coronary artery spasm. The procedure is conducted during coronary angiography.  "The artery-narrowing drug ergonovine (or, alternatively, acetylcholine) is injected to provoke coronary artery spasm.  The person's response to the ergonovine is then documented."  If the individual experiences severe arterial spasm in response to ergonovine, he or she probably has variant angina due to coronary arterial spasm. Coding Instructions: 1. Do code ergonovine provocation in addition to cardiac catheterization if documented. 2. Do not code separately for the injection of the pharmacologic agent, as it is considered part of the test and is not separately reimbursable. Thank you