Summary & Overview
HCPCS C7519: Coronary Angiography with Catheter Placement and Flow Reserve Measurement
HCPCS Level II code C7519 represents a complex coronary angiography procedure that combines catheter placement in native coronary arteries and bypass grafts with intraprocedural contrast injections, imaging supervision and interpretation, and physiologic assessment via intravascular Doppler velocity and/or pressure-derived coronary flow reserve (CFR) during pharmacologic stress. This code captures a bundled diagnostic and physiologic assessment often used in evaluating ischemic heart disease and graft patency, and it matters nationally because it defines billing for advanced coronary physiological assessment performed in cath labs and ASCs.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and the types of services bundled under this code. The publication provides benchmarks and coding context where available, highlights common payer coverage patterns and policy considerations, and outlines implications for facility and professional billing workflows. The content is intended for a national audience of billing professionals, clinical coders, and policy analysts seeking clarity on service composition and billing implications for advanced coronary angiography with CFR measurement.
Billing Code Overview
HCPCS Level II code C7519 describes catheter placement in coronary artery(ies) for coronary angiography with intraprocedural injections, imaging supervision and interpretation, and catheter placement(s) in bypass graft(s) for bypass graft angiography. The service includes intravascular Doppler velocity and/or pressure-derived coronary flow reserve measurement for the initial coronary vessel or graft during coronary angiography, including pharmacologically induced stress.
Service type: Diagnostic coronary angiography with physiologic coronary flow assessment
Typical site of service: Hospital catheterization laboratory (inpatient or outpatient) or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with prior coronary artery bypass grafting (CABG) and progressive exertional angina is admitted for invasive coronary evaluation. The patient reports increased chest pressure with minimal exertion and has an abnormal stress imaging study. Pre-procedure anticoagulation and dual antiplatelet therapy are reviewed. In the cardiac catheterization laboratory under conscious sedation, vascular access is obtained (femoral or radial). Diagnostic coronary angiography is performed with selective catheter placement in native coronary arteries and prior bypass grafts (internal mammary and saphenous vein grafts). Intraprocedural injections of contrast are used for graft and native vessel imaging. Intravascular Doppler velocity and/or pressure-derived coronary flow reserve (CFR) measurements are obtained in an initial coronary vessel or graft, and pharmacologic stress (adenosine or regadenoson) is administered to assess flow reserve. Imaging supervision and interpretation are provided by the attending interventional cardiologist, and procedural documentation includes catheter placements, graft assessment, hemodynamics, CFR results, and any complications. Typical post-procedure workflow includes hemostasis management, monitoring for access site complications, medication reconciliation, and discharge planning or admission depending on findings.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or complexity substantially exceeds typical requirements (document rationale). |