Hi All,
This one has me stumped so I am reaching out for some help.
Provider wants: 93459-26, xu, 51, 92941, 92973, 92975, 92978, 93463, 99152
Single catheter driven to aorta under fluoroscopic guideance. The catheter was then used for left and right coronary angiography with contrast injection under fluoroscopic guidance for left heart catheterization. Catheter was used for vein graft and LIMA angiography as well.
I decided to intervene upon the vein graft to the right coronary artery given no significant mature collaterals. Wire was passed actually without difficulty. Heavy thrombus burden was seen throughout the entire vein graft itself. I then performed percutaneous primary thrombectomy with a cat Rx catheter. We then had significant thrombus extraction. There is still slow flow seen within this vein graft. Intravascular stent appropriate advance which revealed heavy thrombus burden. I then decided to go ahead and deliver pharmacological drugs which included TPA, IV nicardipine, adenosine. These were delivered in moderate doses with TPA at 6mg. Finally we did a balloon angioplasty and this had some improvement of flow. I decided there is a high-grade stenosis in the body of this mid right coronary artery graft. I decided to stent this. This was followed up with no reflow once again. Once again another round of pharmacological drug delivery was done. There was some improvement of the flow however persistent ST elevation is noted.
At this point given the prolonged ST elevations with no improvement despite all pharmacological therapies I decided to stop. Patient will recover in the intensive care unit.
TIMI 0 Flow was seen initially with 100% stenosis. Post procedure 0% stenosis is noted with TIMI I flow.
First off 92978 is not supported. No mention of this in the op note.
The Thrombolysis 92975 and the Pharmacologic agent administration 93463 are bundled with the stent placement. The surgeon is stenting the right coronary ARTERY graft. He is doing the thrombolysis and pharm agent in the vein graft so I assume I can apply modifiers to override the edit?
Am I correct in only coding 93459-26-xu-51, 92941-RC, 92973-RC, and 99152 ( I did not include the verbiage to support 99152 but it is supported). 92975-xs-51?
Thank you,
BB
This one has me stumped so I am reaching out for some help.
Provider wants: 93459-26, xu, 51, 92941, 92973, 92975, 92978, 93463, 99152
Single catheter driven to aorta under fluoroscopic guideance. The catheter was then used for left and right coronary angiography with contrast injection under fluoroscopic guidance for left heart catheterization. Catheter was used for vein graft and LIMA angiography as well.
I decided to intervene upon the vein graft to the right coronary artery given no significant mature collaterals. Wire was passed actually without difficulty. Heavy thrombus burden was seen throughout the entire vein graft itself. I then performed percutaneous primary thrombectomy with a cat Rx catheter. We then had significant thrombus extraction. There is still slow flow seen within this vein graft. Intravascular stent appropriate advance which revealed heavy thrombus burden. I then decided to go ahead and deliver pharmacological drugs which included TPA, IV nicardipine, adenosine. These were delivered in moderate doses with TPA at 6mg. Finally we did a balloon angioplasty and this had some improvement of flow. I decided there is a high-grade stenosis in the body of this mid right coronary artery graft. I decided to stent this. This was followed up with no reflow once again. Once again another round of pharmacological drug delivery was done. There was some improvement of the flow however persistent ST elevation is noted.
At this point given the prolonged ST elevations with no improvement despite all pharmacological therapies I decided to stop. Patient will recover in the intensive care unit.
TIMI 0 Flow was seen initially with 100% stenosis. Post procedure 0% stenosis is noted with TIMI I flow.
First off 92978 is not supported. No mention of this in the op note.
The Thrombolysis 92975 and the Pharmacologic agent administration 93463 are bundled with the stent placement. The surgeon is stenting the right coronary ARTERY graft. He is doing the thrombolysis and pharm agent in the vein graft so I assume I can apply modifiers to override the edit?
Am I correct in only coding 93459-26-xu-51, 92941-RC, 92973-RC, and 99152 ( I did not include the verbiage to support 99152 but it is supported). 92975-xs-51?
Thank you,
BB