Question Need help figuring out what to charge.

missadeel

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Chico, CA
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Procedures​

Coronary angiography
Percutaneous coronary intervention

Pre Procedure Diagnosis​

STEMI

Post Procedure Diagnosis​

STEMI

Indications​

STEMI (ST elevation myocardial infarction) (CMS/HCC) [I21.3 (ICD-10-CM)]


Conclusion​


  • 60% proximal RCA stenosis, 80-90% mid RCA in-stent restenosis and a hazy lesion in the the proximal RPDA.
  • 40% mid LAD after D2, a subtotal occlusion apical LAD, remainder of the vessel has diffuse, mild-moderate luminal irregularities.
  • LCx with mild luminal irregularities.
  • .
  • INTERVENTION:
  • Successful PCI of proximal-mid RCA with Xience Skypoint 3.5 x 12 mm and 3.0 x 32 mm overlapping DES, post dilated with a 3.5 x 12 mm NC balloon to 20 atm.
  • Successful PCI of proximal RPDA with Resolute Onyx 2.0 x 15 mm DES to 16 atm.
  • .
  • PLAN:
  • Admit for post STEMI care
  • DAPT and statin.

PROCEDURE:
The right wrist and and right groin were prepped and draped in a sterile manner.
The soft tissue above the right wrist was locally anesthetized with 1% lidocaine solution.
The right radial artery was accessed with a 20 gauge angiocatheter needle using the through-and-through technique and 6 Fr Glidesheath was placed.

Next, the RCA was engaged with a 5 Fr JR 4 diagnostic catheter and selective angiography was performed in multiple views.
The JR4 was exchanged over a wire for a 5 Fr JL3.5 diagnostic catheter which did not reach the LMCA, therefore, a JL4 was used to perform selective angiography of the left coronary system in multiple views.
The JL4 was exchanged over a wire for a 6 Fr JR4 guide catheter, which was used to engage the RCA. A Prowater wire was advanced down the RCA into the PDA. Angioplasty of the proximal-mid RCA was performed with a 3.0 x 12 mm SC balloon up to 16 atm. Next, a Xience Skypoint 3.0 x 32 mm DES was deployed to 12 atm to the proximal-mid RCA. A second Xience 3.5 x 12 mm DES was deployed to the proximal edge of the other stent to 12 atm. Both stents were post dilated with a 3.5 x 15 mm NC balloon to 20 atm. Next, a Resolute Onxy 2.0 x 15 mm DES was deployed to 16 atm the proximal RPDA.
At the end of the procedure, a equipment was removed and hemostasis was achieved with a radial band.

FINDINGS:
LMCA - Arises from the left sinus of Valsalva, bifurcates into the LAD and LCX. Mild luminal irregularities.

LAD - Arises from the LMCA, gives off a small branching diagonal 1, a moderate caliber, branching diagonal 2, multiple septal perforating branches then wraps around the apex. There is a 40% mid LAD stenosis just after the D2 take-off, a subtotal occlusion of the LAD at the apex and the remainder of the vessel has diffuse, mild-moderate luminal irregularities.

LCX - Arises from the LMCA, gives off a moderate OM1 and a small OM2. There are mild luminal irregularities in the LCx and its branches.

RCA - Arises from the right sinus of Valsalva, gives off a small-moderate PDA and PLB. There is as 60% proximal RCA stenosis, 80-90% mid RCA in-stent restenosis and a hazy lesion in the the proximal RPDA.



 

lnbryant

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Raleigh, NC
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Since there's no documentation of the patient being taken emergently to the cath lab or the culprit vessel for the STEMI, I would code this as a regular PTCA instead of acute MI. If you're billing with C codes for the drug eluting stent, I would code:
C9600 RC
C9601 RC (for rPDA branch)
93454-XU (or -59 for diagnostic coronary angiography)

Just FYI, you should notify the MD that they need to document the percentage of the lesion they treated in the rPDA, they only state it has a "hazy lesion" so if it were audited, the C9601 would be denied because there's no documentation of the lesion being clinically significant. They really should have something documented post each vessel intervention like, "___% lesion was reduced to __%, TIMI flow was ___ prior to intervention and 3 post intervention.
 

missadeel

Contributor
Messages
11
Location
Chico, CA
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Since there's no documentation of the patient being taken emergently to the cath lab or the culprit vessel for the STEMI, I would code this as a regular PTCA instead of acute MI. If you're billing with C codes for the drug eluting stent, I would code:
C9600 RC
C9601 RC (for rPDA branch)
93454-XU (or -59 for diagnostic coronary angiography)

Just FYI, you should notify the MD that they need to document the percentage of the lesion they treated in the rPDA, they only state it has a "hazy lesion" so if it were audited, the C9601 would be denied because there's no documentation of the lesion being clinically significant. They really should have something documented post each vessel intervention like, "___% lesion was reduced to __%, TIMI flow was ___ prior to intervention and 3 post intervention.
Thank you for your response.
 
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