Kcronin1122
Networker
- Messages
- 46
- Best answers
- 0
Hello,
I am fairly new at coding Caths and I am needing help. UHC mcr denied cpt codes 75710 and 36011 saying documentation does not support billing. Can someone explain if this coding is correct? I am still trying to get an understanding of the Caths. Thank you
93531
93566
93567
36010 xu/51
36010 xu/51
36011 51
36216 51
75710 26/xu
76937 26
Description of Procedure:
The procedure included a left and right heart catheterization
with oximetry, hemodynamics, and angiography.
SALLY was brought to the cardiac catheterization lab. After all
consents were checked and the hold points completed, she was
placed in the usual position and was placed under general
anethesia by the anesthesia team. The access site was prepared in
the usual sterile manner. Vascular ultrasound imaging was
utilized to define selected vessel patency. Real-time imaging
was used during vascular access attempts, including visualization
of needle passage into the vessel lumen, due to need minimize
vascular complications. Ultrasound imaging was captured and
placed in the medical record. Access was obtained using the
Seldinger technique in the right jugular vein with a 8 French
sheath and the right femoral artery with a 5 French sheath. I
initially attempted femoral venous access on the right and left
but angiography demonstrated occlusion of the bilateral femoral
veins. After access was obtained and sheaths were placed, a 7
French wedge catheter and a 5F pigtail catheter were utilized to
perform hemodynamic measurements. After sheaths were placed,
Faith was started on Argatroban infusion because of her previous
history of heparin induced thrombocytopenia. The hemodynamics
were fairly unremarkable with Fontan and Glenn pressures of 15
mmHg with an RVEDP of 10 mmHg.
We then proceeded with angiography. The 5F Pigtail was advanced
into the RV for an angiogram. The catheter was then withdrawn
into the Aortic root where angiography was performed. A 7 F
Berman was then used to perform angiography in the Glenn and
Fontan. The Berman was removed and a 4F JR2.5 was advanced into
the innominate vein were an angiogram was performed which
demonstrated a small veno-venous collateral. The JR2.5 was then
removed and a 4F IMA catheter was advanced into the LIMA where
angiography demonstrated no aorto-pulmonary collaterals. The
catheter was then positioned in the RIMA where angiography showed
only trivial AP collaterals. The JR2.5 was removed and the
pigtail was placed in the aorta for monitoring purposes. A 4F
angle glide catheter was advanced through the RIJ sheath into the
IVC and femoral veins in an attempt to re-canalize them but the
was no connection to the distal common femoral vein. This
concluced the procedure
After completion of the procedure, local anesthesia was given at
the access site. The sheaths were removed and hemostasis was
obtained. Faith was extubated and transferred to the CARU in
stable condition. The estimated blood loss was 5 mL. The total
fluoroscopy was DAP 125.5 Gycm2 and Air Kerma 785.37 mgy. 134 ml
of contrast were given in total. She was on an Argatroban
infusion throughout the case for thromboprophylaxis due to
history of heparin induced thrombocytopenia.
There were no complications.
Catheterization Findings:
Qp = 2.77 L/min (1.57 L/min/m2)
Qs = 3.58 L/min (2.03 L/min/m2)
Rp = 1.81 units (3.18 units x m2)
Qp/Qs = 0.77 : 1
Heart Rate: 73 bpm
VO2: 100 ml/min/m2
Hemoglobin: 15.3 gm/dL
Inspired O2: 21%
pH: 7.36
pCO2: 40.5
pO2: 56.1
HCO3: 22.8
Angiography
1. Right femoral vein (4F micropuncture catheter, AP
projection): The right femoral vein is occluded with no residual
tract to the IVC. It is drained through numerous collaterals.
2. Left femoral vein (18 gauge needle, AP projection): The left
femoral vein is occluded with no residual tract to the IVC. It
is drained through numerous collaterals.
3. Right ventricle (5F Pigtail, AP/Lat projections): There is a
dilated right ventricle with normal systolic function and trivial
tricuspid insufficiency. There is an unobstructed RVOT.
4. Aortic Root (5F Pigtail, LAO/Lat projections): There is
trivial neo-aortic insufficiency with an unobstructed DKS
connection with normal filling of the right and left coronary
arteries. There is a mild angiographic narrowing in the proximal
descending aorta. There is mild bilateral AP collateralization.
5. Glenn/SVC (7F Berman, AP/Lat projections): There is an
unobstructed Glenn anastomosis with unobstructed flow into the
bilateral branch pulmonary arteries which demonstrate normal
arborization. There is normal pulmonary venous return during the
levophase with an unobstructed ASD. There is a small veno-venous
collateral from the SVC to the right sided pulmonary veins.
6. Fontan/IVC (7F Berman, AP/Lat projections): There is an
unobstructed Fontan conduit with fairly equal flow to the
bilateral branch pulmonary arteries. There is a small
veno-venous collateral from the right hepatic vein to the right
lower pulmonary vein.
7. Innominate vein (4F JR2.5, AP/Lat projections): There is an
unobstructed innominate vein to the right SVC. There is a small
veno-venous collateral from the innominate vein to the right
upper pulmonary vein.
8. LIMA (4F IMA, AP projection): There is a normal LIMA with no
AP collateralization.
9. RIMA (4F IMA, AP projection): There is a normal RIMA with
previous coils noted in the lumen of the vessel which has
re-canalized with trivial amount of AP collateralization.
Impression:
SALLY is a XX year old female with:
1. Hypoplastic left heart syndrome s/p fenestrated extracardiac
Fontan
A. S/p fenestration with AVP (Dr. Jureidini, 2009)
2. Plastic bronchitis
3. Decreased cardiac output (2.8 L/miin)
4. Qp:Qs 0.8:1
5. Pulmonary hypertension with PVR 3.2 iWU, normal TPG (5 mmHg),
normal mean PA pressure (4-5 mmHg)
6. Unobstructed Fontan circuit (15 mmHg throughout)
7. Mild bilateral AP collateralization
8. Numerous small veno-venous collaterals
9. Bilateral femoral vein occlusion
Thanks in advance for your help!
I am fairly new at coding Caths and I am needing help. UHC mcr denied cpt codes 75710 and 36011 saying documentation does not support billing. Can someone explain if this coding is correct? I am still trying to get an understanding of the Caths. Thank you
93531
93566
93567
36010 xu/51
36010 xu/51
36011 51
36216 51
75710 26/xu
76937 26
Description of Procedure:
The procedure included a left and right heart catheterization
with oximetry, hemodynamics, and angiography.
SALLY was brought to the cardiac catheterization lab. After all
consents were checked and the hold points completed, she was
placed in the usual position and was placed under general
anethesia by the anesthesia team. The access site was prepared in
the usual sterile manner. Vascular ultrasound imaging was
utilized to define selected vessel patency. Real-time imaging
was used during vascular access attempts, including visualization
of needle passage into the vessel lumen, due to need minimize
vascular complications. Ultrasound imaging was captured and
placed in the medical record. Access was obtained using the
Seldinger technique in the right jugular vein with a 8 French
sheath and the right femoral artery with a 5 French sheath. I
initially attempted femoral venous access on the right and left
but angiography demonstrated occlusion of the bilateral femoral
veins. After access was obtained and sheaths were placed, a 7
French wedge catheter and a 5F pigtail catheter were utilized to
perform hemodynamic measurements. After sheaths were placed,
Faith was started on Argatroban infusion because of her previous
history of heparin induced thrombocytopenia. The hemodynamics
were fairly unremarkable with Fontan and Glenn pressures of 15
mmHg with an RVEDP of 10 mmHg.
We then proceeded with angiography. The 5F Pigtail was advanced
into the RV for an angiogram. The catheter was then withdrawn
into the Aortic root where angiography was performed. A 7 F
Berman was then used to perform angiography in the Glenn and
Fontan. The Berman was removed and a 4F JR2.5 was advanced into
the innominate vein were an angiogram was performed which
demonstrated a small veno-venous collateral. The JR2.5 was then
removed and a 4F IMA catheter was advanced into the LIMA where
angiography demonstrated no aorto-pulmonary collaterals. The
catheter was then positioned in the RIMA where angiography showed
only trivial AP collaterals. The JR2.5 was removed and the
pigtail was placed in the aorta for monitoring purposes. A 4F
angle glide catheter was advanced through the RIJ sheath into the
IVC and femoral veins in an attempt to re-canalize them but the
was no connection to the distal common femoral vein. This
concluced the procedure
After completion of the procedure, local anesthesia was given at
the access site. The sheaths were removed and hemostasis was
obtained. Faith was extubated and transferred to the CARU in
stable condition. The estimated blood loss was 5 mL. The total
fluoroscopy was DAP 125.5 Gycm2 and Air Kerma 785.37 mgy. 134 ml
of contrast were given in total. She was on an Argatroban
infusion throughout the case for thromboprophylaxis due to
history of heparin induced thrombocytopenia.
There were no complications.
Catheterization Findings:
Qp = 2.77 L/min (1.57 L/min/m2)
Qs = 3.58 L/min (2.03 L/min/m2)
Rp = 1.81 units (3.18 units x m2)
Qp/Qs = 0.77 : 1
Heart Rate: 73 bpm
VO2: 100 ml/min/m2
Hemoglobin: 15.3 gm/dL
Inspired O2: 21%
pH: 7.36
pCO2: 40.5
pO2: 56.1
HCO3: 22.8
Angiography
1. Right femoral vein (4F micropuncture catheter, AP
projection): The right femoral vein is occluded with no residual
tract to the IVC. It is drained through numerous collaterals.
2. Left femoral vein (18 gauge needle, AP projection): The left
femoral vein is occluded with no residual tract to the IVC. It
is drained through numerous collaterals.
3. Right ventricle (5F Pigtail, AP/Lat projections): There is a
dilated right ventricle with normal systolic function and trivial
tricuspid insufficiency. There is an unobstructed RVOT.
4. Aortic Root (5F Pigtail, LAO/Lat projections): There is
trivial neo-aortic insufficiency with an unobstructed DKS
connection with normal filling of the right and left coronary
arteries. There is a mild angiographic narrowing in the proximal
descending aorta. There is mild bilateral AP collateralization.
5. Glenn/SVC (7F Berman, AP/Lat projections): There is an
unobstructed Glenn anastomosis with unobstructed flow into the
bilateral branch pulmonary arteries which demonstrate normal
arborization. There is normal pulmonary venous return during the
levophase with an unobstructed ASD. There is a small veno-venous
collateral from the SVC to the right sided pulmonary veins.
6. Fontan/IVC (7F Berman, AP/Lat projections): There is an
unobstructed Fontan conduit with fairly equal flow to the
bilateral branch pulmonary arteries. There is a small
veno-venous collateral from the right hepatic vein to the right
lower pulmonary vein.
7. Innominate vein (4F JR2.5, AP/Lat projections): There is an
unobstructed innominate vein to the right SVC. There is a small
veno-venous collateral from the innominate vein to the right
upper pulmonary vein.
8. LIMA (4F IMA, AP projection): There is a normal LIMA with no
AP collateralization.
9. RIMA (4F IMA, AP projection): There is a normal RIMA with
previous coils noted in the lumen of the vessel which has
re-canalized with trivial amount of AP collateralization.
Impression:
SALLY is a XX year old female with:
1. Hypoplastic left heart syndrome s/p fenestrated extracardiac
Fontan
A. S/p fenestration with AVP (Dr. Jureidini, 2009)
2. Plastic bronchitis
3. Decreased cardiac output (2.8 L/miin)
4. Qp:Qs 0.8:1
5. Pulmonary hypertension with PVR 3.2 iWU, normal TPG (5 mmHg),
normal mean PA pressure (4-5 mmHg)
6. Unobstructed Fontan circuit (15 mmHg throughout)
7. Mild bilateral AP collateralization
8. Numerous small veno-venous collaterals
9. Bilateral femoral vein occlusion
Thanks in advance for your help!