Jane5711
Networker
Hi,
I'm not sure how to code this. Please see below, thanks.
PROCEDURE PERFORMED:
1. Left heart cardiac catheterization.
2. Selective coronary artery angiography.
3. Left ventriculography.
4. Right heart cardiac catheterization.
5. Selective bilateral renal artery angiography.
6. Selective right brachiocephalic artery angiography.
7. Selective left subclavian artery angiography to visualize left internal
mammary artery.
8. Selective right brachiocephalic artery angiography to visualize the right
common carotid artery and right subclavian artery and right internal
mammary artery.
9. Unilateral right lower extremity angiography with runoff up to the
popliteal artery to visualize the right external iliac, common femoral
and superficial femoral popliteal arteries.
INDICATION:
1. Abnormal stress test showing fixed inferior defect.
2. Significant coronary artery disease.
3. Risk factors hypercholesterolemia and diabetes mellitus, tobacco smoking.
4. Peripheral artery disease with significant calcification of the right
common femoral artery.
5. Dyspnea.
6. Mitral valve regurgitation.
PROCEDURE: After the informed consent was obtained the patient was prepped
and draped in the usual sterile fashion, 2% lidocaine was used for local in
the right groin. Vascular access was obtained in the right femoral artery and
right femoral vein. Over a guidewire, 7-French angiographic sheath was placed
in the right femoral vein. A 6-French sheath was placed in the right femoral
artery.
A 6-French TD Swan-Ganz catheter was introduced through the right femoral vein
into the pulmonary artery. Right heart cardiac cath performed in routine
fashion.
A 6-French JL4 catheter was introduced over a guidewire in left coronary
artery. Selective left coronary artery angiography was performed.
Over a guidewire, 6-French JR4 catheter was introduced to selectively engage
the middle of the
right coronary artery and selective right coronary artery angiography was
performed.
A 6-French JR4 guide was used to selectively engage the right brachiocephalic
artery. Right brachiocephalic artery angiography was performed to visualize
the right subclavian artery, right common carotid artery and right internal
mammary artery.
Then the JR4 guide was used to engage the left renal artery and left
subclavian artery angiography performed to visualize the left internal mammary
artery.
Then, JR4 catheter was withdrawn over a guidewire to the level of the renal
arteries.
A 6-French JR4 catheter was used to selectively engage the left renal artery.
Selective left renal artery angiography was performed.
A 6-French JR4 guide was used to selectively engage the right renal artery.
Selective right coronary artery. Right renal artery angiography was
performed.
Then, a 6-French pigtail catheter was introduced over guidewire into the left
ventricle. Left ventricle hemodynamics were measured and left
ventriculography in the RAO projection was performed. The pigtail catheter was
removed under hemodynamic monitoring from the left aorta.
Then, the right femoral artery angiography was then done through the right
femoral artery sheath. The angiography was performed to visualize the right
common femoral artery, right external iliac artery, right deep and superficial
femoral arteries and right popliteal artery. Distal runoff performed.
Then, at the end of the diagnostic cardiac cath, the guidewire and diagnostic
catheters were removed. Artery sheath and venous sheaths were removed and
hemostasis obtained with application of manual pressure and hemostatic patch,
and the patient was transferred in a stable condition to the floor for further
care with no complications.
RESULTS:
1. HEMODYNAMIC DATA:.
2. Pulmonary capillary wedge pressure 14/24/14 mm.
3. Pulmonary artery 36/10/21 mm.
4. Right ventricle 39/2/9 mm.
5. Right atrium 10/8/5 mm.
6. Left ventricle 133/2/21 mm.
7. Aorta 130/45/79 mm of mean.
8. Heart rate was 70 beats per minute.
ANATOMIC DATA: Left ventriculography:
1. Anterobasal normal.
2. Anterolateral normal.
3. Apical normal.
4. Inferior normal.
5. Posterobasal normal.
6. Left ventricular ejection fraction is approximately 60% visual estimate
with no significant gradient across the aortic valve noted, no stigmata
insufficiency noted.
CORONARY DATA:
1. Left main coronary artery: The left main coronary artery is a moderate
caliber vessel. It is heavily calcified in its mid and distal portion
with eccentric 50-68% stenosis with dampening of the pressure waveform
upon engagement of the of the left main coronary artery. The left main
coronary bifurcates into left descending artery and left circumflex
arteries.
2. Left circumflex artery: Left circumflex artery has calcifications noted
proximally in its mid portion.
a. Proximal left circumflex artery also has calcification.
b. Proximal left circumflex artery has a calcified eccentric 40-50%
stenosis, then bifurcates into the 1st obtuse marginal branch and the
main circumflex artery.
3. First OM branch is a medium caliber vessel with about 40% stenosis in
midportion and gives rise to subbranch. The rest of the vessel with mild
disease.
a. AV circumflex artery has 30-40% stenosis in its early midportion.
Rest of the vessel has mild-to-moderate diffuse disease and bifurcates
distally into 2 obtuse marginal branches, which are smaller caliber
vessel with mild disease.
b. The distal portion of the left AV circumflex artery, which
bifurcates into 2 obtuse marginal branches, those 2 obtuse marginal
branches could be classified as a 2nd and 3rd obtuse marginal branches.
4. The 2nd obtuse marginal branch is small vessel with mild disease and 3rd
OM branch is a small vessel with mild disease.
5. Left anterior descending artery: Left descending artery is a medium
caliber vessel with calcification noted fluoroscopically in the proximal
portion. It has mild disease in its proximal portion. The proximal
portion gives rise to small first diagonal branch, followed by
bifurcation into the main diagonal branch of the LAD.
a. Just at the bifurcation of the LAD and the diagonal just after the
origin of the second diagonal branch the LAD has eccentric 60% stenosis.
b. The ostial portion of the second diagonal branch is 60% stenosis.
The mid LAD beyond the 60% stenosis has mild diffuse disease. It is a
transapical vessel, curves around the apex.
6. The 2nd OM branch is the main branch of the left anterior descending
artery with an ostial 60-70% stenosis. The rest of the vessel has mild
disease.
7. Right coronary artery: Right coronary artery has calcification noted
throughout its course.
a. Mid right coronary is a dominant vessel.
b. Proximal right artery has long 40% eccentric stenosis.
c. Mid right coronary artery has a 75% smooth tubular calcific
stenosis.
d. Distally the left coronary artery is a medium caliber vessel with
mild diffuse disease. Distally, the right coronary artery bifurcates
into posterior descending branch and a posterolateral branch.
e. The posterior descending branch is an ostial 80% stenosis, the
rest of vessel is about 2 mm caliber vessel with mild disease.
f. Posterolateral branch is a medium caliber vessel with mild diffuse
disease.
8. Right brachiocephalic artery:.
a. The right brachiocephalic artery has mild atherosclerosis, it
bifurcates into the right common carotid artery and right subclavian
artery, both right common carotid right common carotid and right
subclavian artery have mild plaquing without any high-grade focal
stenosis.
b. The right internal mammary artery arises from the right renal
artery and it is medium caliber vessel without any significant disease.
9. Left subclavian artery. The left subclavian artery has mild plaquing.
There is no significant disease. It gives rise to a left internal mammary
artery, which is a medium caliber vessel without any significant disease.
10.Left renal artery: Left renal artery has about 30% stenosis in its
proximal portion. Rest of the vessel has no significant disease.
11.Right renal artery has about no significant disease.
12.Right external iliac artery: Right external iliac artery has mild disease
with moderate calcification in the midportion with a 30% eccentric
stenosis.
13.Right common femoral artery: Right common femoral artery is heavily
calcified. There is an eccentric 60% stenosis in the right common
femoral artery. The moderate calcific lesion extends to the bifurcation
of the right common femoral artery into right deep femoral and right
superficial femoral artery.
14.Right deep femoral artery: Right deep femoral artery has no significant
disease.
15.Right superficial femoral artery: Right superficial femoral artery is
calcified in its course. It has 30-40% proximal stenosis, 50% mid
stenosis and the rest of the vessel has mild disease. It continues on in
the right popliteal artery.
16.Right popliteal artery: Right popliteal artery is not seen in its entire
course and has mild disease without any high-grade focal stenosis.
IMPRESSIONS:
1. Severe 2 vessel coronary artery disease with 50% to 60% eccentric
calcific stenosis of the mid and distal left main coronary artery; 75%
stenosis of the midportion of the right artery with 30% to 40% stenosis
of the proximal portion of the right coronary artery; 60-65% eccentric
stenosis of the mid LAD just after origin of the second diagonal branch
with a 75% ostial stenosis of the second diagonal branch; left circumflex
artery with a 40% calcific eccentric stenosis in proximal portion and
mild disease of the first obtuse marginal branch and __________
circumflex artery.
2. Overall good left ventricular systolic function with near normal
pulmonary capillary wedge pressure and PA systolic pressure about 36 mmHg
with a mean of 21 mmHg.
3. Patent renal arteries bilaterally with a 30% stenosis of the proximal
left renal artery, mild disease of the right renal artery.
4. Patent right brachiocephalic artery and right subclavian artery and right
common carotid artery and patent right internal mammary artery; patent
left renal artery and patent left internal mammary artery.
5. Peripheral artery disease with moderate to severe calcific lesion in the
right common femoral artery with a 50-60% calcific stenosis in the right
common femoral artery, 50% stenosis of the right superficial femoral
artery, mild disease of the right external iliac artery and right
popliteal arteries.
Not sure what to code:
93461,26
36252, 59
sedation - which was not noted.
Do I need to code 75710, 26 for the brachiocephalic artery angiography or is this included in the 93461,26? How about the iliac angio, fem pop, superficial femoral artery. Would these also be covered under the cath code 93461, 26 or would 75710,26 be used? Please let me know. Thanks,
Many thanks,
Jane
I'm not sure how to code this. Please see below, thanks.
PROCEDURE PERFORMED:
1. Left heart cardiac catheterization.
2. Selective coronary artery angiography.
3. Left ventriculography.
4. Right heart cardiac catheterization.
5. Selective bilateral renal artery angiography.
6. Selective right brachiocephalic artery angiography.
7. Selective left subclavian artery angiography to visualize left internal
mammary artery.
8. Selective right brachiocephalic artery angiography to visualize the right
common carotid artery and right subclavian artery and right internal
mammary artery.
9. Unilateral right lower extremity angiography with runoff up to the
popliteal artery to visualize the right external iliac, common femoral
and superficial femoral popliteal arteries.
INDICATION:
1. Abnormal stress test showing fixed inferior defect.
2. Significant coronary artery disease.
3. Risk factors hypercholesterolemia and diabetes mellitus, tobacco smoking.
4. Peripheral artery disease with significant calcification of the right
common femoral artery.
5. Dyspnea.
6. Mitral valve regurgitation.
PROCEDURE: After the informed consent was obtained the patient was prepped
and draped in the usual sterile fashion, 2% lidocaine was used for local in
the right groin. Vascular access was obtained in the right femoral artery and
right femoral vein. Over a guidewire, 7-French angiographic sheath was placed
in the right femoral vein. A 6-French sheath was placed in the right femoral
artery.
A 6-French TD Swan-Ganz catheter was introduced through the right femoral vein
into the pulmonary artery. Right heart cardiac cath performed in routine
fashion.
A 6-French JL4 catheter was introduced over a guidewire in left coronary
artery. Selective left coronary artery angiography was performed.
Over a guidewire, 6-French JR4 catheter was introduced to selectively engage
the middle of the
right coronary artery and selective right coronary artery angiography was
performed.
A 6-French JR4 guide was used to selectively engage the right brachiocephalic
artery. Right brachiocephalic artery angiography was performed to visualize
the right subclavian artery, right common carotid artery and right internal
mammary artery.
Then the JR4 guide was used to engage the left renal artery and left
subclavian artery angiography performed to visualize the left internal mammary
artery.
Then, JR4 catheter was withdrawn over a guidewire to the level of the renal
arteries.
A 6-French JR4 catheter was used to selectively engage the left renal artery.
Selective left renal artery angiography was performed.
A 6-French JR4 guide was used to selectively engage the right renal artery.
Selective right coronary artery. Right renal artery angiography was
performed.
Then, a 6-French pigtail catheter was introduced over guidewire into the left
ventricle. Left ventricle hemodynamics were measured and left
ventriculography in the RAO projection was performed. The pigtail catheter was
removed under hemodynamic monitoring from the left aorta.
Then, the right femoral artery angiography was then done through the right
femoral artery sheath. The angiography was performed to visualize the right
common femoral artery, right external iliac artery, right deep and superficial
femoral arteries and right popliteal artery. Distal runoff performed.
Then, at the end of the diagnostic cardiac cath, the guidewire and diagnostic
catheters were removed. Artery sheath and venous sheaths were removed and
hemostasis obtained with application of manual pressure and hemostatic patch,
and the patient was transferred in a stable condition to the floor for further
care with no complications.
RESULTS:
1. HEMODYNAMIC DATA:.
2. Pulmonary capillary wedge pressure 14/24/14 mm.
3. Pulmonary artery 36/10/21 mm.
4. Right ventricle 39/2/9 mm.
5. Right atrium 10/8/5 mm.
6. Left ventricle 133/2/21 mm.
7. Aorta 130/45/79 mm of mean.
8. Heart rate was 70 beats per minute.
ANATOMIC DATA: Left ventriculography:
1. Anterobasal normal.
2. Anterolateral normal.
3. Apical normal.
4. Inferior normal.
5. Posterobasal normal.
6. Left ventricular ejection fraction is approximately 60% visual estimate
with no significant gradient across the aortic valve noted, no stigmata
insufficiency noted.
CORONARY DATA:
1. Left main coronary artery: The left main coronary artery is a moderate
caliber vessel. It is heavily calcified in its mid and distal portion
with eccentric 50-68% stenosis with dampening of the pressure waveform
upon engagement of the of the left main coronary artery. The left main
coronary bifurcates into left descending artery and left circumflex
arteries.
2. Left circumflex artery: Left circumflex artery has calcifications noted
proximally in its mid portion.
a. Proximal left circumflex artery also has calcification.
b. Proximal left circumflex artery has a calcified eccentric 40-50%
stenosis, then bifurcates into the 1st obtuse marginal branch and the
main circumflex artery.
3. First OM branch is a medium caliber vessel with about 40% stenosis in
midportion and gives rise to subbranch. The rest of the vessel with mild
disease.
a. AV circumflex artery has 30-40% stenosis in its early midportion.
Rest of the vessel has mild-to-moderate diffuse disease and bifurcates
distally into 2 obtuse marginal branches, which are smaller caliber
vessel with mild disease.
b. The distal portion of the left AV circumflex artery, which
bifurcates into 2 obtuse marginal branches, those 2 obtuse marginal
branches could be classified as a 2nd and 3rd obtuse marginal branches.
4. The 2nd obtuse marginal branch is small vessel with mild disease and 3rd
OM branch is a small vessel with mild disease.
5. Left anterior descending artery: Left descending artery is a medium
caliber vessel with calcification noted fluoroscopically in the proximal
portion. It has mild disease in its proximal portion. The proximal
portion gives rise to small first diagonal branch, followed by
bifurcation into the main diagonal branch of the LAD.
a. Just at the bifurcation of the LAD and the diagonal just after the
origin of the second diagonal branch the LAD has eccentric 60% stenosis.
b. The ostial portion of the second diagonal branch is 60% stenosis.
The mid LAD beyond the 60% stenosis has mild diffuse disease. It is a
transapical vessel, curves around the apex.
6. The 2nd OM branch is the main branch of the left anterior descending
artery with an ostial 60-70% stenosis. The rest of the vessel has mild
disease.
7. Right coronary artery: Right coronary artery has calcification noted
throughout its course.
a. Mid right coronary is a dominant vessel.
b. Proximal right artery has long 40% eccentric stenosis.
c. Mid right coronary artery has a 75% smooth tubular calcific
stenosis.
d. Distally the left coronary artery is a medium caliber vessel with
mild diffuse disease. Distally, the right coronary artery bifurcates
into posterior descending branch and a posterolateral branch.
e. The posterior descending branch is an ostial 80% stenosis, the
rest of vessel is about 2 mm caliber vessel with mild disease.
f. Posterolateral branch is a medium caliber vessel with mild diffuse
disease.
8. Right brachiocephalic artery:.
a. The right brachiocephalic artery has mild atherosclerosis, it
bifurcates into the right common carotid artery and right subclavian
artery, both right common carotid right common carotid and right
subclavian artery have mild plaquing without any high-grade focal
stenosis.
b. The right internal mammary artery arises from the right renal
artery and it is medium caliber vessel without any significant disease.
9. Left subclavian artery. The left subclavian artery has mild plaquing.
There is no significant disease. It gives rise to a left internal mammary
artery, which is a medium caliber vessel without any significant disease.
10.Left renal artery: Left renal artery has about 30% stenosis in its
proximal portion. Rest of the vessel has no significant disease.
11.Right renal artery has about no significant disease.
12.Right external iliac artery: Right external iliac artery has mild disease
with moderate calcification in the midportion with a 30% eccentric
stenosis.
13.Right common femoral artery: Right common femoral artery is heavily
calcified. There is an eccentric 60% stenosis in the right common
femoral artery. The moderate calcific lesion extends to the bifurcation
of the right common femoral artery into right deep femoral and right
superficial femoral artery.
14.Right deep femoral artery: Right deep femoral artery has no significant
disease.
15.Right superficial femoral artery: Right superficial femoral artery is
calcified in its course. It has 30-40% proximal stenosis, 50% mid
stenosis and the rest of the vessel has mild disease. It continues on in
the right popliteal artery.
16.Right popliteal artery: Right popliteal artery is not seen in its entire
course and has mild disease without any high-grade focal stenosis.
IMPRESSIONS:
1. Severe 2 vessel coronary artery disease with 50% to 60% eccentric
calcific stenosis of the mid and distal left main coronary artery; 75%
stenosis of the midportion of the right artery with 30% to 40% stenosis
of the proximal portion of the right coronary artery; 60-65% eccentric
stenosis of the mid LAD just after origin of the second diagonal branch
with a 75% ostial stenosis of the second diagonal branch; left circumflex
artery with a 40% calcific eccentric stenosis in proximal portion and
mild disease of the first obtuse marginal branch and __________
circumflex artery.
2. Overall good left ventricular systolic function with near normal
pulmonary capillary wedge pressure and PA systolic pressure about 36 mmHg
with a mean of 21 mmHg.
3. Patent renal arteries bilaterally with a 30% stenosis of the proximal
left renal artery, mild disease of the right renal artery.
4. Patent right brachiocephalic artery and right subclavian artery and right
common carotid artery and patent right internal mammary artery; patent
left renal artery and patent left internal mammary artery.
5. Peripheral artery disease with moderate to severe calcific lesion in the
right common femoral artery with a 50-60% calcific stenosis in the right
common femoral artery, 50% stenosis of the right superficial femoral
artery, mild disease of the right external iliac artery and right
popliteal arteries.
Not sure what to code:
93461,26
36252, 59
sedation - which was not noted.
Do I need to code 75710, 26 for the brachiocephalic artery angiography or is this included in the 93461,26? How about the iliac angio, fem pop, superficial femoral artery. Would these also be covered under the cath code 93461, 26 or would 75710,26 be used? Please let me know. Thanks,
Many thanks,
Jane