93458 + Aortogram

amym

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Can I bill for the Aortogram? Why or why not?

SUMMARY:

-- CORONARY CIRCULATION:
-- Coronary angiography demonstrated minor luminal irregularities.

-- CARDIAC STRUCTURES:
-- Global left ventricular function was normal. EF calculated by contrast
ventriculography was 55 %.

-- SPLANCHNIC AND RENAL VESSELS:
-- The renal arteries were widely patent and grossly angiographically
normal. Two left renal arteries were identified, a single right renal
artery was also idenitified.

PROCEDURES PERFORMED:

-- Left heart catheterization with ventriculography.
-- Left coronary angiography.
-- Right coronary angiography.
-- Aortography.

RECOMMENDATIONS:
The patient should continue with the present medications.

INDICATIONS: Angina/MI: atypical chest pain. Coronary artery disease:
abnormal stress test. Renal: malignant HTN.

VENTRICLES: There were no left ventricular global or regional wall motion
abnormalities. Global left ventricular function was normal. EF calculated
by contrast ventriculography was 55 %.

CORONARY VESSELS: Coronary angiography demonstrated minor luminal
irregularities. Left main: Normal. The vessel was medium sized but short.
LAD: Angiography showed mild atherosclerosis. Circumflex: The vessel was
large sized (dominant). Angiography showed mild atherosclerosis. Distal
circumflex: Angiography showed moderate atherosclerosis. RCA: The vessel
was small sized. Angiography showed moderate atherosclerosis.

ABDOMINAL VESSELS: The renal arteries were widely patent and grossly
angiographically normal. Two left renal arteries were identified, a single
right renal artery was also idenitified.

PROCEDURE: The risks and alternatives of the procedures and conscious
sedation were explained to the patient and informed consent was obtained.
The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile
fashion.

-- Right femoral artery access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.

-- Left heart catheterization. A catheter was advanced to the ascending
aorta. After recording ascending aortic pressure, the catheter was
advanced across the aortic valve and left ventricular pressure was
recorded. Ventriculography was performed using power injection of contrast
agent. Imaging was performed using an RAO projection.

-- Left coronary artery angiography. A catheter was advanced to the aorta
and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.

-- Right coronary artery angiography. A catheter was advanced to the
aorta and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.

-- Aortography. A catheter was placed and contrast was injected.

COMPLICATIONS:
There were no adverse outcomes.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
Test started at 15:45. Test concluded at 15:58. RADIATION EXPOSURE:
Fluoroscopy time: 1.9 min.
HEMOSTASIS:
The sheath was removed. The site was compressed manually. Hemostasis was
successful.
MEDICATIONS GIVEN:
Midazolam, 1 mg, IV, at 15:41.
Fentanyl, 25 mcg, IV, at 15:41.
Midazolam, 1 mg, IV, at 15:42.
1% Lidocaine, 20 ml, subcutaneously, at 15:45.
CONTRAST GIVEN:
Omnipaque 60 ml.

STUDY DIAGRAM

HEMODYNAMIC TABLES

Pressures: NO PHASE
Pressures: - HR: 73
Pressures: - Rhythm:
Pressures: -- Aortic Pressure (S/D/M): 140/76/100
Pressures: -- Left Ventricle (s/edp): 137/8/--

Outputs: NO PHASE
Outputs: -- CALCULATIONS: Age in years: 56.86
Outputs: -- CALCULATIONS: Body Surface Area: 2.44
Outputs: -- CALCULATIONS: Height in cm: 183.00
Outputs: -- CALCULATIONS: Sex: Male
Outputs: -- CALCULATIONS: Weight in kg: 124.70
 

Jim Pawloski

True Blue
Messages
1,289
Location
Ann Arbor
Best answers
0
Can I bill for the Aortogram? Why or why not?

SUMMARY:

-- CORONARY CIRCULATION:
-- Coronary angiography demonstrated minor luminal irregularities.

-- CARDIAC STRUCTURES:
-- Global left ventricular function was normal. EF calculated by contrast
ventriculography was 55 %.

-- SPLANCHNIC AND RENAL VESSELS:
-- The renal arteries were widely patent and grossly angiographically
normal. Two left renal arteries were identified, a single right renal
artery was also idenitified.

PROCEDURES PERFORMED:

-- Left heart catheterization with ventriculography.
-- Left coronary angiography.
-- Right coronary angiography.
-- Aortography.

RECOMMENDATIONS:
The patient should continue with the present medications.

INDICATIONS: Angina/MI: atypical chest pain. Coronary artery disease:
abnormal stress test. Renal: malignant HTN.

VENTRICLES: There were no left ventricular global or regional wall motion
abnormalities. Global left ventricular function was normal. EF calculated
by contrast ventriculography was 55 %.

CORONARY VESSELS: Coronary angiography demonstrated minor luminal
irregularities. Left main: Normal. The vessel was medium sized but short.
LAD: Angiography showed mild atherosclerosis. Circumflex: The vessel was
large sized (dominant). Angiography showed mild atherosclerosis. Distal
circumflex: Angiography showed moderate atherosclerosis. RCA: The vessel
was small sized. Angiography showed moderate atherosclerosis.

ABDOMINAL VESSELS: The renal arteries were widely patent and grossly
angiographically normal. Two left renal arteries were identified, a single
right renal artery was also idenitified.

PROCEDURE: The risks and alternatives of the procedures and conscious
sedation were explained to the patient and informed consent was obtained.
The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile
fashion.

-- Right femoral artery access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.

-- Left heart catheterization. A catheter was advanced to the ascending
aorta. After recording ascending aortic pressure, the catheter was
advanced across the aortic valve and left ventricular pressure was
recorded. Ventriculography was performed using power injection of contrast
agent. Imaging was performed using an RAO projection.

-- Left coronary artery angiography. A catheter was advanced to the aorta
and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.

-- Right coronary artery angiography. A catheter was advanced to the
aorta and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.

-- Aortography. A catheter was placed and contrast was injected.

COMPLICATIONS:
There were no adverse outcomes.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
Test started at 15:45. Test concluded at 15:58. RADIATION EXPOSURE:
Fluoroscopy time: 1.9 min.
HEMOSTASIS:
The sheath was removed. The site was compressed manually. Hemostasis was
successful.
MEDICATIONS GIVEN:
Midazolam, 1 mg, IV, at 15:41.
Fentanyl, 25 mcg, IV, at 15:41.
Midazolam, 1 mg, IV, at 15:42.
1% Lidocaine, 20 ml, subcutaneously, at 15:45.
CONTRAST GIVEN:
Omnipaque 60 ml.

STUDY DIAGRAM

HEMODYNAMIC TABLES

Pressures: NO PHASE
Pressures: - HR: 73
Pressures: - Rhythm:
Pressures: -- Aortic Pressure (S/D/M): 140/76/100
Pressures: -- Left Ventricle (s/edp): 137/8/--

Outputs: NO PHASE
Outputs: -- CALCULATIONS: Age in years: 56.86
Outputs: -- CALCULATIONS: Body Surface Area: 2.44
Outputs: -- CALCULATIONS: Height in cm: 183.00
Outputs: -- CALCULATIONS: Sex: Male
Outputs: -- CALCULATIONS: Weight in kg: 124.70
Yes you can! If the patient has Medicare, code G0275, non Medicare 75625.
HTH,
Jim Pawloski, CIRCC
 
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