could i bill 36225 with combo cath?

bhargavi

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After obtaining informed consent, the patient was prepped and draped in sterile fashion.  A 6 French sheath was inserted in the right common femoral artery.  A second 6 French sheath was inserted and right common femoral vein.  A 6 French Judkins left and right coronary catheters were used for left and right coronary angiography.  Iliofemoral angiography revealed presence of sheath in the common femoral artery.  A mynx closure device was used to close the right common femoral artery access site.

I attest that moderate conscious sedation was provided under my direct supervision with the sedation trained nurse using 1 mg of intravenous Versed and 50 mcg of fentanyl to sedate the patient.  Start time 9:29 AM and end time was 9:54 AM.  There were no complications.  See nurse's sedation sheet, for complete pre-and post service details.

Hemodynamics:

The left ventricular end-diastolic pressure was 12 mmHg. The aortic pressure was 153/41 mmHg. Next

Right heart catheterization:

Pulmonary capillary mean wedge pressure of 11 mmHg.
Pulmonary artery pressure of 33/4 with mean pressure of 17 mmHg.
Right ventricular pressure of 35/-3 with RV end-diastolic pressure of 1 mmHg.
Right atrial mean pressure of 2 mmHg.
Fick cardiac output of 3.40 L/min.  Fick cardiac index of 2.17 L/min/m².

Coronary Angiography:

Right coronary artery is a medium to large caliber dominant vessel with mild diffuse proximal disease, patent mid to distal segment.  RPDA and RPL are small caliber vessels with luminal irregularities.

Left Main coronary artery is patent.

Left anterior descending is a large caliber vessel with patent proximal segment, mid diffuse 30% stenosis, patent distal segment.  This is a type III wraparound LAD.  There are 2 small diagonal branches with mild luminal irregularities.

Left circumflex is a medium caliber vessel with patent proximal, mid, distal segment.  Obtuse marginal 1 is a large caliber vessel luminal irregularities.

Left ventriculogram: Left ventricular cavity was entered using 6 French JR4 diagnostic catheter and LVEDP was measured at 12 mmHg.

Subclavian angiography: Left subclavian angiography revealed 100% proximal stump occlusion without any distal filling noted.

The patient was then transferred to the recovery area in stable condition:

thanks in advance
could I bill 93460, 36225-LT?
 

arclayton

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It depends on why the subclavian angiography was performed. If the MD is looking for a bypass graft, code as 93461 (See CPT Assistant December 2011). If the doctor is looking for thoracic outlet syndrome, you can code 36225.
 

Jim Pawloski

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I agree with the 93461 code, but not 36225. 36225 is looking at the vertebral circulation from the subclavian artery. If you are looking for thoracic outlet syndrome, I would code 36215 (modifier for what side) and 75710 (modifier for what side) for extremity arteriogram.
HTH,
Jim Pawloski, CIRCC
 
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