Billing and Coding: Cardiac Catheterization and Coronary Angiography

Medicare covers cardiac catheterization and coronary angiography when the medical record documents medical necessity (relevant history, exam, and pertinent test results) and claims include valid ICD-10-CM diagnosis codes and required ordering/referring provider information. Detailed documentation is required including signed procedure reports, angiogram interpretations, and retained imaging; ABN rules and specific modifiers (GA, GX, GZ, GY) must be applied as instructed and may trigger automatic denials or additional claim elements (e.g., occurrence code 32 for Part A GA claims). Diagnostic coronary angiography should not be separately billed if a prior angiogram within six months already established the decision for the same interventional procedure.

"Cardiac catheterization and coronary angiography are covered when the medical record documents medical necessity, including relevant medical history, physical examination, and results of pertinent ..."