Sorry, I didn't give the detail on that part. Under the heading INTRAVASCULAR ULTRASOUND it says:
"IVUS showed that the distal left anterior descending measured 1.9 to 2 mm in diameter. There was very severe plaquing within the distal end of the stent extending proximally. In the stent just distal to where the diagonal branch was, the stent was narrowed in comparison to distal and proximally. Pulling back into the left main showed that there was very little plaquing in the left main."
There was severe stenosis in the mid to distal LAD, at the distal end of the previously placed stent as well as some plaque that was displaced just distal to the origin of the stented diagonal. It was billed as 92978-26-LD and 92979-26-LC. I am just cleaning up some else's old A/R and trying to make sense of it all. I have four similar cases where I think the 93454 should be written off.
#1 is 93454 with 92980, done the day after a cath showing stenosis in the LAD and held overnight for intervention.
#2 is this patient with the 93458 by Dr. A and then 93454, 92995-LD, 92978-LD and 92979-LC by Dr. B
#3 is another patient with 93459 by Dr. A and then 93454, 92980-LD, 93978-LD and 92979-LC by Dr. B
#4 is pt with possible end stage aortic stenosis with 3 vessel coronary dz. They started with an angiogram thru the RFA from the descending aorta arch all the way to the femoral arteries to assess safety of using an intraaortic balloon pump, which was then done through the LFA. It then says they put a guiding catheter in the RFA. They did the IVUS thru the LAD and left main, then proceeded with stent placements in the LAD and LC, where stents were also placed. Balloon pump was removed. Here's what was billed: 36200-59 (bundles, but okay with -59 for diagnostic view?), 75630, 33967, 33968 (bundles), 93454-59 (bundles), 92980-LD, 92981-LC, 92978-LD, 92979-LC.
In this last case, I believe the 33968 and 93454 should be written off/refunded if paid.
Your insight is GREATLY appreciated!
Thanks!