I need help coding this appropiately, plz !

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1) LEFT HEART CATH
2) EMERGENT TRANSVENOUS TEMPORARY PACER
3) SUCCESSFUL PCI STENING OF RIGHT CORONARY ARTERY WITH DRUG ELUTING STENT.

LEFT VENTRICULOGRAM
(L) ventriculogram performed which showed (L) ventricular end diastolic pressure of 25 to 30mml lg. Ejectoin fraction of 50-55% w/mild to moderate inferior hypokinesis.

INTERVENTIONAL PROCEDURE:
After confirmation of the culprit lesion being the (r) coronary artery, proceeded with a JR4 guide, a floppy wire and 2.5 x 15 balloon. Had difficulty engaging the ostium of the (R) coronary artery. There was severe diffuse spasm noted of the (R) coronary on engagement of the guide, however, the pressure wave forms were not dampened. Proceeded w/wiring the lesion and were able to cross the100% occlusin with adequate distal positioning of the wire and restoration of flow. There was minimal thrombus noted @ the primary site of the lesion. Angioplasty was performed of the primary lesion w/restoration of TIMI 2-1/2flow..It was noted there was an ostial dissection noted @ the ostium of the (R) coronary artery. During this, the patient went into ventricular tachycardia/ventricular fibrillation. Was awake initially, however then became hypertensive and unresponsive. 300 jules shock was given. The pt did come back. Also had evidence of bradycardia with a very transient episode of second degree AV block versus high degree block. However, this was very transient. Responded to atropine. A 6-french sheath was placed in the (R) femoral vein following which a temporary transvenous pacer was placed. The pt was very briefly paced, however he did go back into normal rhythm. Repeat angiograms demonstrated spiral dissection all the way from the ostium down to the primary culpit region; proceeded with stenting all the way from the primary culprit lesion in the mid RCA back to the ostium, Pt received three Promus stents 2.3x2.8mm followed by 2.75x28mm, followed by 2.75x12mm for complete coverage of the mid to proximal RCA including ostium. The stents were successfully post dilated w/excellent angiographic result with no evidence of proximal or distal edge dissection. No evidence of staining of the aorta was noted. Final angiograms demostrated excellent result.

FINAL ASSESSMENT:
1) Acute inferior wall myocardial infarct with 100% occlusion to the (R) coronary artery (RCA) and severe diffuse and calcified disease of tthe proximal portion as well as the ostium
2) Procedure complicated by guide-induced dissection fo the ostium which spiraled down to primary culprit lesion in mid RCA
3. Sussessful angioplasty, stenting of culprit lesion with 2.5x28mm Promus drug-eluting stent followed by successful stenting and angioplasty of the proximal RCA with a 2.75x128 Promus overlapping drug eluting stent and successful stenting of the ostium of the RCA with a 2.75 x12 Promus drug eluting stent with excellent angiographic result.
4. Ejection fraction of 50-55% with inferior hypokinesis.
 

Cyndi113

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Hi there,

Was this a diagnostic cath? If not, then you can bill only the stents, 92980. If yes, bill the LHC, 26, 59 + 92980. BTW, is this the full procedure? Because for the LHC, I only see the ventriculogram. There are no coronaries done? How did the MD know the RC was 100% occluded?

You cannot bill for the temp pacemaker unfortunately. If the vent tachy/fib was present at admission, then you can bill for it. However if it was caused by cath, then no.
 
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Need help coding

Cyndi,

Appreciate your help.............response to diagnostic?
HISTORY: Gentleman with HTN, DM, HX of heavy smoking who presented to ER w/dizziness and syncope, noticed to have an acute inferior wall ST elevation.......
Was brought emergently to cath lab.

RE: Coronaries done? The report says after temporary transvenous pacer was placed,
REPEAT ANGIOGRAMS demonstrated spiral dissection all the way from the ostium down to the primary culprit region, therefore proceeded with stenting.
 

Jim Pawloski

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Cyndi,

Appreciate your help.............response to diagnostic?
HISTORY: Gentleman with HTN, DM, HX of heavy smoking who presented to ER w/dizziness and syncope, noticed to have an acute inferior wall ST elevation.......
Was brought emergently to cath lab.

RE: Coronaries done? The report says after temporary transvenous pacer was placed,
REPEAT ANGIOGRAMS demonstrated spiral dissection all the way from the ostium down to the primary culprit region, therefore proceeded with stenting.
The repeat angiogram was from the PTCA, so that is not diagnostic or billable. You need first to see both coronaries selected and imaged, along with the LV gram to say "Coronaries + Left heart catheterization (93458).
HTH,
Jim Pawloski, R.T. (CV), CIRCC
 
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