CPT Code 93454: CPT Code for coronary artery bypass graft

CPT Code 93454 is a commonly used cardiac catheterization procedure code in cardiovascular medicine. This code is used to report left heart catheterization combined with coronary angiography, an essential diagnostic procedure for evaluating coronary artery disease (CAD). Understanding when and how to use this code ensures accurate medical billing, prevents claim denials, and improves reimbursement compliance for cardiology practices.

Code Description: What Is CPT Code 93454?

CPT 93454 refers to:

“Catheter placement in coronary arteries for coronary angiography, including intraprocedural injections for imaging, supervision, and interpretation; with left heart catheterization including intraprocedural injections for left ventriculography, when performed.”

This code is used when both coronary angiography and left heart catheterization are performed without right heart catheterization.

Category & Code Type

Coding Criteria for CPT 93454

Use CPT 93454 when all the following are performed:

• Catheter placement into the coronary arteries
• Diagnostic coronary angiography
• Left heart catheterization
• Includes imaging supervision and interpretation
• No right heart catheterization performed (if done, use 93458 instead)

Documentation Must Support:

• Medical necessity for cardiac catheterization
• Symptoms prompting the procedure (e.g., chest pain, abnormal stress test)
• Diagnostic findings or clinical rationale
• Imaging results and interpretations
• Confirmation that right heart cath was not performed

Billing Guidelines for CPT 93454

Proper billing ensures full reimbursement and compliance:

Key Billing Rules:

• Bill 93454 once per session unless repeat medically necessary procedure is documented.
• Include appropriate ICD-10-CM diagnosis codes supporting medical necessity (e.g., I20.9, I25.10, R07.9).
• If a right heart cath is also performed, use 93458, not 93454.
• Modifier Use for CPT 93454

Note: Medicare and commercial payers may bundle certain services. Always check NCCI edits.

Payer Considerations

• Medicare requires documentation showing medical necessity for diagnostic imaging.
• Some insurers may require prior authorization, especially when part of outpatient cardiac testing.

Documentation Tips for Accurate Claim Submission

To avoid denials, include:

Procedure Indication: reason for the angiography
Detailed Procedure Note: vessels catheterized, contrast used, findings
Imaging Reports: include interpretation results
Complications (if any): document additional care if provided
Separately Billable Services: ensure no unbundled codes are included

Common Examples of Use

CPT 93454 is typically used in situations such as:

Example 1: Suspected Coronary Artery Disease

A patient presents with chest pain and abnormal EKG. Cardiologist performs a left heart cath and coronary angiography to assess for CAD.

Example 2: Pre-Intervention Evaluation

Before placing a coronary stent, the physician performs a diagnostic angiography to evaluate coronary anatomy.

Example 3: Abnormal Stress Test Follow-Up

A nuclear stress test shows perfusion defects; diagnostic cath with coronary angiography is performed for confirmation.

Common Mistakes & Reasons for Denials

Incorrectly billing 93454 when right heart cath is also done (should be 93458)
Missing medical necessity documentation
Not applying modifier 26 or TC correctly for split billing
Unbundling imaging services already included in 93454

Key Takeaways

• CPT 93454 covers coronary angiography + left heart catheterization.
• Do not use if right heart catheterization is also performed.
• Proper documentation and modifier use are essential for full reimbursement.
• Supports diagnosis of coronary artery disease and related cardiac conditions.

FAQ

What is CPT 93454 used for?

CPT 93454 is used for billing coronary angiography with left heart catheterization performed for cardiac diagnostic evaluation.

Does 93454 include imaging and interpretation?

Yes. It includes supervision, interpretation, and intraprocedural injections.

Can I bill 93454 and 93458 together?

No. 93458 includes both right and left heart catheterization with coronary angiography, so 93454 should not be billed together with it.

What modifiers are commonly used with CPT 93454?

Modifier 26 (professional) and TC (technical) are most commonly used depending on the billing entity.

Is left ventriculography included in 93454?

Yes, if performed. If not performed, the code remains the same—no reduction.

Summary

CPT 93454 is a diagnostic code for coronary angiography with left heart catheterization to evaluate coronary artery disease or chest pain. It includes catheter placement, imaging, and interpretation. Use 93454 only when a right heart cath is not done (otherwise use 93458). Documentation must show medical necessity and procedure details. Common modifiers: 26 (professional) and TC (technical).

Reference Sources

Here are credible, authoritative sources you may cite or link to for verification and compliance:

Source	Link
AMA CPT® Professional Codebook	https://www.ama-assn.org/practice-management/cpt
CMS Physician Fee Schedule (MPFS)	https://www.cms.gov/medicare/physician-fee-schedule/
CMS National Correct Coding Initiative (NCCI) Edits	https://www.cms.gov/medicare/national-correct-coding-initiative
AHA Coding Clinic for HCPCS	https://www.aha.org/coding-clinic
ACC (American College of Cardiology) – Cath/PCI Guidelines	https://www.acc.org
Medicare Coverage Database	https://www.cms.gov/medicare-coverage-database/

Note: Always consult the latest AMA CPT codebook, as CPT codes are copyrighted by the AMA and updated annually.