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Interventional Cardiology Coding Questions

4

4mercedheart

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Messages
4
I am new to billing and I find myself starting with interventional cardiology.
At this time I have 2 cases that are completely throwing me and the gal training me off. How do I code these?
1) LHC; PCI of LAD-(1st vessel), PCI of Ramus Artery, Angioseal. DX ACS

2)
LHC; Cor angio, LV Angio, SVG Angio, LIMA Angio; Aortic Arch Angio; Right Innominate Artery Angio, Angioseal
DX: 414.01, 411.1

Any help would be greatly appreciated.
 
need more details or maybe the reports.
1) were the coronaries imaged or just the left ventricle?
PCI isn't specific enough, what kind of intervention was performed in each vessel?
angioseal is never separately billable

2) LHC w/ coronaries w/ grafts - 93459
arch angiography 93567 w/ diagnosis V15.1 - typically done to look for additional grafts (need report)
right innominate (need report)
 
Procedure performed:
1. Left Heart cardiac catheterization
2. Selective left and right coronary angiography
4. Left ventriculography
4.AORTIC ROOT ANGIOGRAM (Doctor's Caps)

Description of procedure:
After informed consent, the patient was brought to the cardiac cath room. He was prepped and draped in the usual sterile fashion. A 6 French sheath was placed in the right femoral artery using the Seldinger technique with out difficulty or complications. 6 French JL and pigtail catheters were used to perform the selective angiography in multiple projections and angulations.
Following diagnostic angiography, a femoral arety angiogram was performed. a 6French Angioseal was deployed for access site closure.

2)Procedure Performed:
1. Left hear cardiac catheterization
2. Selective left and right coronary angiography
3. Left ventriculography
4. LIMA ANGIOGRAPHY
5. SVG ANGIOGRAPHY
6. RIGHT INNOMINATE ARTERY ANGIOGRAM
7. AORTIC ARCH ANGIOGRAM

Description of Procedure:
After informed consent, the patient was brought to the cardiac cath room. He was prepped and draped in the usual sterile fashion. A 6French sheath was placed in the right femoral artery using the Seldinger technique without difficulty or complications. 6 Fench JL, JR and pigtail catheters were used to perform selective angiography in multiple projections and angulations.
Following diagnostic angiography, a femoral artery angiogram was performed. A6French Angioseal was deployed for access site closure
 
4mercedheart said:
Procedure performed:
1. Left Heart cardiac catheterization
2. Selective left and right coronary angiography
4. Left ventriculography
4.AORTIC ROOT ANGIOGRAM (Doctor's Caps)

Description of procedure:
After informed consent, the patient was brought to the cardiac cath room. He was prepped and draped in the usual sterile fashion. A 6 French sheath was placed in the right femoral artery using the Seldinger technique with out difficulty or complications. 6 French JL and pigtail catheters were used to perform the selective angiography in multiple projections and angulations.
Following diagnostic angiography, a femoral arety angiogram was performed. a 6French Angioseal was deployed for access site closure.

2)Procedure Performed:
1. Left hear cardiac catheterization
2. Selective left and right coronary angiography
3. Left ventriculography
4. LIMA ANGIOGRAPHY
5. SVG ANGIOGRAPHY
6. RIGHT INNOMINATE ARTERY ANGIOGRAM
7. AORTIC ARCH ANGIOGRAM

Description of Procedure:
After informed consent, the patient was brought to the cardiac cath room. He was prepped and draped in the usual sterile fashion. A 6French sheath was placed in the right femoral artery using the Seldinger technique without difficulty or complications. 6 Fench JL, JR and pigtail catheters were used to perform selective angiography in multiple projections and angulations.
Following diagnostic angiography, a femoral artery angiogram was performed. A6French Angioseal was deployed for access site closure
Click to expand...

We need the findings to determine if the injections/ imaging are appropriate. On your first case, I cannot tell if a LHC was performed, or why an aortic root imaging was performed. The second case, I see possible Left Heart Cath w/ grafts, but there is not enough documentation for the aortic arch.

Thanks,
Jim Pawloski, CIRCC
 
Jim Pawloski said:
We need the findings to determine if the injections/ imaging are appropriate. On your first case, I cannot tell if a LHC was performed, or why an aortic root imaging was performed. The second case, I see possible Left Heart Cath w/ grafts, but there is not enough documentation for the aortic arch.

Thanks,
Jim Pawloski, CIRCC
Click to expand...

yep, need more info. documentation looks detailed so I'm sure the "findings" section will show us exactly what he looked at. why do you struggle coding these types of procedures? if we knew that then maybe we could give you the right info so you can easily code it yourself
 
Problems with coding

The reason I am having problems coding these procedures, as I stated in my first thread, I have NEVER billed before and was just thrown into it a month ago with basically no training.
I saw this site and thought it would be a tremendous help, but if I am too much of a bother, I'll try to find answers elsewhere.
 
Findings

1)(for LHC; PCI of LAD; PCI of Ramus Artery)
Findings: The diagnostic angiography was characterized by LEFT dominant coronary anatomy.
Left Main: The left main is normal
LAD: The LAD is a large vessel with an 80% MID LAD LESION, AND DIFFUSE DISEASE OTHERWISE.
Circumflex: The Circumflex artery is LARGE WITH MILD DIFFUSE DIDISEASE
RAMUS: LARGE WITH PROXIMAL 95% STENOSIS
RCA: The RCA is VERY LARGE CALIBER VESSEL, DOMINANT, FREE OF SIGNIFICANT DISEASE
LEFT VENTRULOGRAPHY:IN THE RAO PROJECTION AHOWED NORMAL SYSTOLIC FUNCTION AND CONTRACTILITY WITH LVEF 55%
Impression:
1. 2 vessel CAD
2. Successful PCI of MID LAD 80% to 0%, Proximal Ramus 95% to 0%, with a Bare Metal Stent.
3. EF 55%


2)(for LHC, Cor Angio, LV Angio, SVG Angio, Lima Angio, Aortic Arch Angio, Right Innominate Artery Angio)
DIAGNOSTIC CORONARY ANGIOGRAPHY FINDINGS:
The diagnostic angiography was characterized by RIGHT dominant coronary anatomy.
Left Main: The left main is normal.
LAD: The LAD is a large vessel WITH A MID 90% LESION, DISTAL VESSEL SUPPLIED BY A WIDELY PATENT LIMA GRAFT.
Circumflex: The circumflex artery is LARGE, WITH MILD DIFFUSE DISEASE, OM2 HAS A PROXIMAL 80% STENOSIS
RCA: THE RCA IS LARGE, WITH MILD TO MODERATE DIFUSE DISEASE. RIGHT PDA HAS A PROXIMAL 80% STENOSIS
LIMA TO LAD: LARGE, WIDELY PATENT
SVG TO RCA WIDELY PATENT
SVG TO OM2: WIDELY PATENT
AORTIC ARCH:TYPE 3 BOVINE ARCH WITH COMMON LEFT SUBCLAVIAN AND LEFT CAROTID ARTERIES PROXIMALLY
RIGHT INNOMINATE ARTERY: LARGE, WIDELY PATENT WITH NO SIGNIFICANT DISEASE

LEFT VENTRICULOGRAPHY: In the RAO projection, showed LVEF 55%.

Impression:
1. 3V NATIVE CAD, WITH WIDELY PATENT GRAFTS TO LAD, OM2, RCA
2. EF 55%
 
4mercedheart said:
The reason I am having problems coding these procedures, as I stated in my first thread, I have NEVER billed before and was just thrown into it a month ago with basically no training.
I saw this site and thought it would be a tremendous help, but if I am too much of a bother, I'll try to find answers elsewhere.
Click to expand...

it's not a bother but I'm sure you know the old saying..."teach a man to fish..." so it would be much better to show you what to look for instead of just giving the answers that way you don't have to post every report you come across.

procedure #1
92928 - RI
PCI of mid-LAD??? what kind of PCI???
93458-26-59
no findings or appropriate indication for aortic root angiography

procedure #2
93459-26
93567
no indication for innominate angiogram...looks like just runoff from aortic root injection
 
Last edited:
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