Hello, I am new to Cardiology, I am having trouble with a claim. We are getting denied for incorrect coding and not supported by documentation. Here is the doctor's note for the procedure. The coding sent was 36215, LT,59, 36215, RT,59, 36223,50, 75630,26,59, and 93458,26,59.
Coronary angiogram operative report
Indication: Known CAD, severe shortness of breath, abnormal carotid, claudication with active smoking
Procedures performed:
1. Right retrograde radial access
2. Selective right and left coronary angiography and left ventriculography.
3. Selective bilateral carotid angiography with supervision interpretation.
4. Selective bilateral subclavian angiography with vertebral runoffs with supervision and interpretation.
5. Distal aortography with bilateral iliac runoffs.
Procedure details:
After obtaining consent, access of the right radial placed a 5 French sheath. A standard radial cocktail was given to prevent arterial spasm. I performed left and right coronary angiography using a Tiger 5 French catheter for the right, a JL 3 5 catheter for the left main and a pigtail for the left ventricle. Simmons 2 was used to perform carotid and vertebral angiography. Long pigtail was used to perform distal aortography and iliac angiography At the end of the procedure, all catheters and wires were taken out. No complication occurred. The patient was taken off the table in stable condition. TR band was applied for hemostasis.
Findings:
-LM: Large short vessel with no disease.
-LAD: Proximal calcified disease 50%. Stent is patent in the midsegment. Diagonal distally have no disease.
-LCx: Large, Dominant vessel with no proximal disease. OM1 has a small with no disease OM 2 has severe eccentric 80% stenosis. Left PDA is patent.
-RCA: Nondominant small vessel no disease.
-LV : normal LV systolic function. EF equal 60%. LV filling pressure elevated at 20 mmHg. No gradient across aortic valve.
-Distal aorta shows no aneurysm formation both common iliacs external iliacs are patent. Left hypogastric is occluded right is diseased
Carotid findings:
– Left vertebral is codominant with no disease.
– The right vertebral is large with no disease.
– The left carotid is widely patent no disease. The left internal carotid has an eccentric 20% disease with a bulging proximal segment. The ECA has no disease
– The right carotid is widely patent no disease the bulb is no disease both external generic show no disease in the cervical segment
Conclusion:
1. Patent LAD stent with moderate in-stent restenosis with severe atherosclerosis of the OM 2 branch.
2. Preserved LV systolic function with elevated LV filling pressure.
3. No evidence of carotid or vertebral disease.
4. Left hypogastric occlusion.
Recommend dual antiplatelet therapy. If the patient tolerates Plavix and is pliant, he can be brought back for vascularization stenting of the OM 2 branch
I am thinking the correct coding should be 36217, 36224, 36225, 75630, and 93458. CPT 93458 was paid. The other codes are the ones I am trying to understand. The doctor codes his own procedures, so I am trying to understand in detail the procedures in order to explain to him any changes I am doing.
Thanks in advance! I appreciate it!
Coronary angiogram operative report
Indication: Known CAD, severe shortness of breath, abnormal carotid, claudication with active smoking
Procedures performed:
1. Right retrograde radial access
2. Selective right and left coronary angiography and left ventriculography.
3. Selective bilateral carotid angiography with supervision interpretation.
4. Selective bilateral subclavian angiography with vertebral runoffs with supervision and interpretation.
5. Distal aortography with bilateral iliac runoffs.
Procedure details:
After obtaining consent, access of the right radial placed a 5 French sheath. A standard radial cocktail was given to prevent arterial spasm. I performed left and right coronary angiography using a Tiger 5 French catheter for the right, a JL 3 5 catheter for the left main and a pigtail for the left ventricle. Simmons 2 was used to perform carotid and vertebral angiography. Long pigtail was used to perform distal aortography and iliac angiography At the end of the procedure, all catheters and wires were taken out. No complication occurred. The patient was taken off the table in stable condition. TR band was applied for hemostasis.
Findings:
-LM: Large short vessel with no disease.
-LAD: Proximal calcified disease 50%. Stent is patent in the midsegment. Diagonal distally have no disease.
-LCx: Large, Dominant vessel with no proximal disease. OM1 has a small with no disease OM 2 has severe eccentric 80% stenosis. Left PDA is patent.
-RCA: Nondominant small vessel no disease.
-LV : normal LV systolic function. EF equal 60%. LV filling pressure elevated at 20 mmHg. No gradient across aortic valve.
-Distal aorta shows no aneurysm formation both common iliacs external iliacs are patent. Left hypogastric is occluded right is diseased
Carotid findings:
– Left vertebral is codominant with no disease.
– The right vertebral is large with no disease.
– The left carotid is widely patent no disease. The left internal carotid has an eccentric 20% disease with a bulging proximal segment. The ECA has no disease
– The right carotid is widely patent no disease the bulb is no disease both external generic show no disease in the cervical segment
Conclusion:
1. Patent LAD stent with moderate in-stent restenosis with severe atherosclerosis of the OM 2 branch.
2. Preserved LV systolic function with elevated LV filling pressure.
3. No evidence of carotid or vertebral disease.
4. Left hypogastric occlusion.
Recommend dual antiplatelet therapy. If the patient tolerates Plavix and is pliant, he can be brought back for vascularization stenting of the OM 2 branch
I am thinking the correct coding should be 36217, 36224, 36225, 75630, and 93458. CPT 93458 was paid. The other codes are the ones I am trying to understand. The doctor codes his own procedures, so I am trying to understand in detail the procedures in order to explain to him any changes I am doing.
Thanks in advance! I appreciate it!