We have a cardiologist who wants to bill 75600 for Ascending Aortogram in aortic root during heart catheterization, I don't think 75600 is appropriate since its not in thoracic aorta, but then I was looking at CPT 93567, but documentation doesn't state he injected any dye. Is anyone familiar with these codes?
Or is it just not billable based on documentation??
PREANGIOGRAPHY DIAGNOSES:
1. Recurrent chest pain, rule out progression of obstructive coronary artery
disease.
2. History of redo CABG and multiple PCIs.
POSTANGIOGRAPHY DIAGNOSES:
1. Progression of obstructive coronary artery disease:
a. 80% to 90% eccentric stenosis involving the distal left main coronary
artery, supplying a widely patent circumflex artery.
b. Occluded proximal segment of the left anterior descending artery.
c. Occluded proximal segment of the right coronary artery.
d. More than 80% stenosis involving the proximal segment of the saphenous vein
graft to the ramus intermediate artery, with evidence of patent stent in the
mid and distal segment of the graft.
e. Widely patent saphenous vein graft to the distal left anterior descending
artery.
f. All other bypass grafts are occluded, including the previously noted
occluded LIMA graft.
2. Preserved left ventricular function.
3. Successful coronary stent placement in the proximal segment of the SVG to
the ramus intermediate artery, reducing the 85% stenotic lesion to 10% to 15%
residual.
PROCEDURES PERFORMED:
Left heart catheterization, left ventriculography, selective coronary
arteriography, bypass graft visualization, ascending aortogram study, and
SonoSite ultrasound guidance.
DESCRIPTION OF PROCEDURE:
Diagnostic coronary angiogram study was performed via the right femoral artery.
SonoSite ultrasound was utilized to confirm patency of the right femoral
artery for arterial access. Then, a #6-French introducer sheath was advanced
into the right femoral artery. The left coronary system was cannulated with a
Judkins left #6-French diagnostic catheter. The right coronary artery was
cannulated with a Judkins right #6-French diagnostic catheter. All other
bypass grafts were visualized with the right coronary diagnostic catheter. All
images were taken in the RAO and LAO projections. Images were adequate for
interpretation. Contrast injection was used to visualize the coronary
arteries.
Then, the pigtail catheter was advanced across the aortic valve into the left
ventricle. Left ventriculogram was then performed in the RAO projection with
contrast injection.
Left ventriculogram demonstrates normal contractility. Overall, left
ventricular ejection fraction is 60%. The mitral valve and the aortic valve
are normal. The left ventricular end-diastolic pressure is 20 mmHg.
Then, the pigtail catheter was pulled back into the ascending aorta. It was
positioned in the aortic root. Ascending aortogram was then performed in the
LAO projection. There was no evidence of aortic aneurysm. There was no
additional bypass graft visualized.
After completion of the diagnostic angiogram study, PCI was then performed on
the SVG to the ramus intermediate artery. Angiomax was administered according
to protocol. The SVG was then cannulated with a #6-French Amplatz 1 guiding
catheter. A Run-Through guidewire was then advanced to the distal SVG.
Initial attempt to advance a stent was not successful. Then, the significantly
stenotic lesion was pre-dilated with a 2.5 mm balloon, followed by a 3.0 mm
balloon. Subsequently, with a buddy wire technique, a 3.0 mm x 22 mm Onyx
drug-eluting stent was placed into the proximal segment of the saphenous vein
graft to the ramus intermediate artery, covering the original lesion in the
proximal segment. The residual stenosis post stent placement was postdilated
with a 3.25 mm x 12 mm noncompliant balloon, up to 20 atmospheres. There was
residual stenosis of 10% to 20%. TIMI-3 flow was noted distally. There were
no complications and the patient tolerated the procedure well.
After completion of the PCI, the right groin arteriotomy site was then closed
with an Angio-Seal device. The patient received an additional 150 mg of Plavix
and 325 mg of aspirin in the cath lab. The patient has been on dual
anti-platelet therapy at home.
The plan is to bring the patient back for staged PCI with rotational
atherectomy of the distal left main lesion in 3 to 4 weeks.
Or is it just not billable based on documentation??
PREANGIOGRAPHY DIAGNOSES:
1. Recurrent chest pain, rule out progression of obstructive coronary artery
disease.
2. History of redo CABG and multiple PCIs.
POSTANGIOGRAPHY DIAGNOSES:
1. Progression of obstructive coronary artery disease:
a. 80% to 90% eccentric stenosis involving the distal left main coronary
artery, supplying a widely patent circumflex artery.
b. Occluded proximal segment of the left anterior descending artery.
c. Occluded proximal segment of the right coronary artery.
d. More than 80% stenosis involving the proximal segment of the saphenous vein
graft to the ramus intermediate artery, with evidence of patent stent in the
mid and distal segment of the graft.
e. Widely patent saphenous vein graft to the distal left anterior descending
artery.
f. All other bypass grafts are occluded, including the previously noted
occluded LIMA graft.
2. Preserved left ventricular function.
3. Successful coronary stent placement in the proximal segment of the SVG to
the ramus intermediate artery, reducing the 85% stenotic lesion to 10% to 15%
residual.
PROCEDURES PERFORMED:
Left heart catheterization, left ventriculography, selective coronary
arteriography, bypass graft visualization, ascending aortogram study, and
SonoSite ultrasound guidance.
DESCRIPTION OF PROCEDURE:
Diagnostic coronary angiogram study was performed via the right femoral artery.
SonoSite ultrasound was utilized to confirm patency of the right femoral
artery for arterial access. Then, a #6-French introducer sheath was advanced
into the right femoral artery. The left coronary system was cannulated with a
Judkins left #6-French diagnostic catheter. The right coronary artery was
cannulated with a Judkins right #6-French diagnostic catheter. All other
bypass grafts were visualized with the right coronary diagnostic catheter. All
images were taken in the RAO and LAO projections. Images were adequate for
interpretation. Contrast injection was used to visualize the coronary
arteries.
Then, the pigtail catheter was advanced across the aortic valve into the left
ventricle. Left ventriculogram was then performed in the RAO projection with
contrast injection.
Left ventriculogram demonstrates normal contractility. Overall, left
ventricular ejection fraction is 60%. The mitral valve and the aortic valve
are normal. The left ventricular end-diastolic pressure is 20 mmHg.
Then, the pigtail catheter was pulled back into the ascending aorta. It was
positioned in the aortic root. Ascending aortogram was then performed in the
LAO projection. There was no evidence of aortic aneurysm. There was no
additional bypass graft visualized.
After completion of the diagnostic angiogram study, PCI was then performed on
the SVG to the ramus intermediate artery. Angiomax was administered according
to protocol. The SVG was then cannulated with a #6-French Amplatz 1 guiding
catheter. A Run-Through guidewire was then advanced to the distal SVG.
Initial attempt to advance a stent was not successful. Then, the significantly
stenotic lesion was pre-dilated with a 2.5 mm balloon, followed by a 3.0 mm
balloon. Subsequently, with a buddy wire technique, a 3.0 mm x 22 mm Onyx
drug-eluting stent was placed into the proximal segment of the saphenous vein
graft to the ramus intermediate artery, covering the original lesion in the
proximal segment. The residual stenosis post stent placement was postdilated
with a 3.25 mm x 12 mm noncompliant balloon, up to 20 atmospheres. There was
residual stenosis of 10% to 20%. TIMI-3 flow was noted distally. There were
no complications and the patient tolerated the procedure well.
After completion of the PCI, the right groin arteriotomy site was then closed
with an Angio-Seal device. The patient received an additional 150 mg of Plavix
and 325 mg of aspirin in the cath lab. The patient has been on dual
anti-platelet therapy at home.
The plan is to bring the patient back for staged PCI with rotational
atherectomy of the distal left main lesion in 3 to 4 weeks.