Ask Dr. Z

Do you know if there is any place in one of Dr. Zielske's books where it says certain edits do not apply to children with congenital heart defects?  I'm specifically wondering about angiography prior to an intervention.  CPT says the intervention includes all angiography for roadmapping and hemodynamic data, but the physician says this edit doesn't apply if it's a child with a congenital heart defect.   I'm trying to find a place in one of his books to support the fact that 93531 is included in 92997 unless the angiography a true diagnostic procedure as defined by CPT.

CPT says:  Diagnostic angiography performed at the time of an interventional procedure is separately reportable if:
1. No prior catheter-based angiographic study is available and a full diagnostic study is performed, and the decision to intervene is based on the diagnostic study, OR
2. A prior study is available, but as documented in the medical record:
a. The patient's condition with respect to the clinical indication has changed since the prior study, OR
b. There is inadequate visualization of the anatomy and/or pathology, OR
c. There is a clinical change during the procedure that requires new evaluation outside the target area of intervention.

Thanks for your help!  Jane