Cath report

zizdreli

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What do you think?
I was thinking
93458, 36215, 75710?
Honestly im never really sure when to use the 75710 so any help/info on it would be greatly appreciated.


REPORT TITLE: catherization report

PROCEDURES PERFORMED
1. Left heart cathetgerization
2. Selective coronary angiography
3. Left ventriculography
4. Left subclavian/LIMA angiography

CONCIOUS SEDATION TIME: 20 minutes

PERCLOSE: right common femoral artery

PRE AND POSTOP DIAGNOSIS: CAD/angina pectoris

INDICATION FOR PROCEDURE: 72 year old man with history of exertional chest pain since February first noted while he was shoveling snow. Subsequent treadmill test where he exercised for 6 mins was both clinically and electronically abnormal. The patient was subsequently referred for cardiology consultation and cardiac catherization with possible mechanical revascularization.

ACCESS: A 6 french sheat right common femoral artery

CATHERERS USED: A 6 french jr4, angled pigtail catherers

EBL: less than 10 ml

RESULTS:
HEMODYNAMICS: aortic pressure 120/70. Left ventricular systolic pressure 120, left ventricular end diagnostic 15 mmhg. No aortic valve gradient on cathether pullback.

LEFT VENTRICULOGRAPHY: left ventricle is of normal size and demonstrates normal systolic function. Visually est fraction is 50-55%. No significant mitral regurgitation.

SELECTIVE CORONARY ANGIOGRAPHY:
LEFT MAIN: The left main is a moderate caliber vessel notable for eccentric 70% distal stenosis involving origins of the LAD and left circumflex.
LAD: The LAD is a small to moderaye calliber transapical vessel notable for a 50% proximal disease involving the origins of the first septal perforator and first diagonal brancj. First diagonal branch is notable for diffuse 30% proximal disease.
LEFT CIRCUMFLEX: Small caliber non dominant vessel. First obtuse marginal is notable for diffuse 50% proximal disease.
RIGHT CORONARY ARTERY: The RCA is a small moderate caliber dominant vessel, which becomes subtotaled in its mid segment with incomplete distal filling.
The distal arteryfills via left to right collaterals.
LEFT SUBCLAVIAN AND LIMA ANGIOGRAPHY: The left subclavian is widely patent. The LIMA is widely patent, appears tp be suitable conduit for bypass grafting.

SUMMARY AND CONCLUSIONS:
1. Diffuse left main/three vessel coronary artery disease as describes.
2. Normal left ventricular size and systolic function
3. No aortic stenosis on catheter pullback
4. No significant mitral regurgitation
5. Successful perclose right common femoral artery

PLAN: Patient will be referred for coronary artery bypass graft surgery.
 

ED752

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Hello,

Our practice bills 93459 if the physician visualizes the LIMA as a potential graft (and documents findings) AND refers the patient for bypass. I think that’s all I would bill if this were my case. Hope this helps.
 

arclayton

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Hi Zizdreli! I agree with your coding, 93459 should only be used when the patient already has a bypass graft.

I was wrong! I just checked a CPT Assistant from December 2011:
“To further clarify, in the uncommon situation in which angiography of the right or left internal mammary artery is performed to determine suitability for use during future bypass surgery (eg, due to prior thoracic surgery or radiation), the appropriate diagnostic cardiac catheterization with angiography code (93455, 93457, 93459, or 93461) should be reported based on the total catheterization components performed.”
 
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