LIMA graft

[kdeterman]

If a patient has a LIMA graft to the LAD and is undergoing a LHC, and had ventriculogram, coronary angiography and angio of the LIMA graft, would you code both 93539 and 93540 in addition to 93510, 93545, 93556, 93555, and 93543?

the only graft the patient has is the LIMA.

I am confused as to whether I would code this as 93539 only, for the LIMA angio only. Or if I would code only 93540 since it is also a graft. Or if I would use both 93539 and 93540 since technically it is both.

Any insight to help me clarify this would be greatly appreciated. Thank you.

[sbicknell]

If the patient is a post-bypass patient with a LIMA bypass then code the 93539.

The 93539 is for any bypass that used an artery to do the bypass. The most common artery the surgeon pulls is the Left Internal Mammary artery (LIMA)

The 93540 is for any bypass that used a vein to do the bypass. The most common vein they pull is the Saphenous vein from the upper leg.

Use Dx V45.81 to show this is a post-bypass patient

Sometimes the Cath will show the bypass conduits (artery or vein) are disease or plugged. If the LIMA graft is, then you can code 414.04. For a vein bypass you can code 414.02

93539 Injection procedure during cardiac catheterization; for selective opacification of arterial conduits (eg, internal mammary), whether native or used for bypass

93540 Injection procedure during cardiac catheterization; for selective opacification of aortocoronary venous bypass grafts, 1 or more coronary arteries

[kdeterman]

thank you. After I posted the question I went back to my CPT book and saw the arterial and venous distinction between 93539 and 93540. I am new to cardio coding and have lots more to learn. Thank you so much for your assistance. I also appreciate the additional information pertaining to dx codes.