cardiac catheterization coding help

loril1983

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Please help me understand the difference between coronary angiography and cardiac catheterization.

If a doctor dictates a procedure and states in the op report:

1. Selective right coronary angiography. A 6F FR4 Expo 100cm catheter was advanced into the right coronary vessel ostium under fluoroscopic guidance. Contrast was injected. Images were obtained in multiple projections.

2. Selective left coronary angiography. A catheter was advanced into the left coronary vessel ostium under fluoroscopic guidance. Contrast was injected. Images were obtained in multiple projections.

3.Left heart catheterization with angiography. A 6F Pig 145 catheter was advanced across the aortic valve to the left ventricle under fluoroscopic guidance. 30ml of contrast was injected at 10 ml/s.

1&2 equal a coronary angiography - CPT 93454 if done alone without #3 (how and why). With number 3, the procedure is a 93458?

I'm having difficulties understanding when to code for a 93454 and when to code 93456-93461. It throws me off when they say "a catheter was advanced", it makes me think they did a cath, not just an angiography (93454).

Please help as I'm super lost!
 

rlh27

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In a coronary angiography, a cath is placed in the artery to take pictures.

In a left hart cath, they advance the cath into the left side of the heart and they take pictures of the vessels and the lower part of the heart (left ventricle)

I think it's a 93458, but can't be sure without the full note.

The LHC also includes catheterization of the left atrium and aorta when performed with the LV catheterization. It includes all hemodynamic measurements (with and without maneuvers and/or infusions or medication), blood sampling and shunt determinations as part of the procedure. Placement of multiple catheters and their repositioning or replacement is included in this procedure. Injection procedures for selective opacification of cardiac chambers or structures, arteries and conduits and the supervision and interpretation of such services are reimbursable as part of all-inclusive codes for these services.
 
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