Kcronin1122
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Hi All,
I am hoping to get some input on billing this procedure.
My doctor is wanting to bill CPT codes;
93533
93567
93568
92992
75825
75827
76937
36620
CPT code 92992 was deleted in 2021, so I am having trouble figuring out what it should be replaced with. Any input would be appreciated.
Description of Procedure:
The procedure included a right and left heart diagnostic
catheterization with angiography and balloon atrial septostomy.
PATIENT was brought to the cardiac catheterization lab.
After all consents were checked and the hold points completed,
she was placed in the usual position and was placed under general
anethesia by the anesthesia team. After all consents were checked
and the hold point completed, the chest was prepped by our
surgical colleagues. The access site was prepared in the usual
sterile manner. Vascular ultrasound imaging was utilized to
define selected vessel patency. Real-time imaging was used
during vascular access attempts, including visualization of
needle passage into the vessel lumen, due to need minimize
vascular complications. Ultrasound imaging was captured and
placed in the medical record. Access was obtained using the
Seldinger technique in the left femoral vein with a 5 French
sheath and the right femoral artery with a 2.5 French x 5 cm
arterial line. After access was obtained and sheaths were placed,
a 5 French wedge catheter and a 4F Glide catheter were utilized
to perform hemodynamic measurements.
After hemodynamics were obtained, angiograms were performed in
the descending aorta with a 3 French Mongoose pigtail. The
ascending aorta was noted to arise from the mid-ductus. Due to
the concern for retroaortic arch obstruction with complete
stenting of the ductus, as well as the potential to leave ductal
tissue uncovered by stent if multiple non-contiguous stents were
placed, PDA stenting was aborted. Following this, banding of the
branch pulmonary arteries was performed (please see separate
report for details). Post banding surface echocardiogram
demonstrated tight bands, with an RPA velocity of 3.75 m/s and a
LPA velocity of 4 m/s.
After bilateral pulmonary artery banding was completed, brief
transthoracic echo was performed to interrogate the septum
directly prior to the intervention. Pressure pullback across the
atrial septum demonstrated a 2-4 mmHg gradient. An 0.018 Nitrex
wire was advanced into the left atrium with the help of the 4F
Glide catheter. The Glide was then removed and the 5F short
sheath was exchanged for a 6F short sheath. A 2 mL BBraun
septostomy balloon was prepared and advanced over the Nitrex wire
to the RA and across the atrial septum into the LA without
difficulty. The balloon was inflated on the LA side and
investigated by both fluoro and echocardiography to ensure
positioning against the atrial septum and away from the mitral
valve. Rashkind atrial septostomy was performed with a pull
across the atrial septum using a 1 ml filled balloon, with a
clear "pop" felt. A second pull with a 1.5 ml balloon was
completed, again with a "pop" felt. The septum was again
interrogated by echocardiography. With satisfactory results by
echo, the Glide catheter was replaced and used to perform an
additional LA-RA pullback to assess the hemodynamic effect of the
procedure. There was no apparent residual gradient.
.
After completion of the procedure, the left femoral sheath was
removed and hemostasis was obtained. The right femoral arterial
line was left sutured in place. PATIENT was kept intubated and
transferred to the PICU in stable condition. The estimated blood
loss was 5 mL. The total fluoroscopy was DAP 2 cGycm2 and Air
Kerma 44 mgy. 19 ml of contrast were given in total. A total of
450 units of IV heparin were given throughout the case.
There were no complications.
I am hoping to get some input on billing this procedure.
My doctor is wanting to bill CPT codes;
93533
93567
93568
92992
75825
75827
76937
36620
CPT code 92992 was deleted in 2021, so I am having trouble figuring out what it should be replaced with. Any input would be appreciated.
Description of Procedure:
The procedure included a right and left heart diagnostic
catheterization with angiography and balloon atrial septostomy.
PATIENT was brought to the cardiac catheterization lab.
After all consents were checked and the hold points completed,
she was placed in the usual position and was placed under general
anethesia by the anesthesia team. After all consents were checked
and the hold point completed, the chest was prepped by our
surgical colleagues. The access site was prepared in the usual
sterile manner. Vascular ultrasound imaging was utilized to
define selected vessel patency. Real-time imaging was used
during vascular access attempts, including visualization of
needle passage into the vessel lumen, due to need minimize
vascular complications. Ultrasound imaging was captured and
placed in the medical record. Access was obtained using the
Seldinger technique in the left femoral vein with a 5 French
sheath and the right femoral artery with a 2.5 French x 5 cm
arterial line. After access was obtained and sheaths were placed,
a 5 French wedge catheter and a 4F Glide catheter were utilized
to perform hemodynamic measurements.
After hemodynamics were obtained, angiograms were performed in
the descending aorta with a 3 French Mongoose pigtail. The
ascending aorta was noted to arise from the mid-ductus. Due to
the concern for retroaortic arch obstruction with complete
stenting of the ductus, as well as the potential to leave ductal
tissue uncovered by stent if multiple non-contiguous stents were
placed, PDA stenting was aborted. Following this, banding of the
branch pulmonary arteries was performed (please see separate
report for details). Post banding surface echocardiogram
demonstrated tight bands, with an RPA velocity of 3.75 m/s and a
LPA velocity of 4 m/s.
After bilateral pulmonary artery banding was completed, brief
transthoracic echo was performed to interrogate the septum
directly prior to the intervention. Pressure pullback across the
atrial septum demonstrated a 2-4 mmHg gradient. An 0.018 Nitrex
wire was advanced into the left atrium with the help of the 4F
Glide catheter. The Glide was then removed and the 5F short
sheath was exchanged for a 6F short sheath. A 2 mL BBraun
septostomy balloon was prepared and advanced over the Nitrex wire
to the RA and across the atrial septum into the LA without
difficulty. The balloon was inflated on the LA side and
investigated by both fluoro and echocardiography to ensure
positioning against the atrial septum and away from the mitral
valve. Rashkind atrial septostomy was performed with a pull
across the atrial septum using a 1 ml filled balloon, with a
clear "pop" felt. A second pull with a 1.5 ml balloon was
completed, again with a "pop" felt. The septum was again
interrogated by echocardiography. With satisfactory results by
echo, the Glide catheter was replaced and used to perform an
additional LA-RA pullback to assess the hemodynamic effect of the
procedure. There was no apparent residual gradient.
.
After completion of the procedure, the left femoral sheath was
removed and hemostasis was obtained. The right femoral arterial
line was left sutured in place. PATIENT was kept intubated and
transferred to the PICU in stable condition. The estimated blood
loss was 5 mL. The total fluoroscopy was DAP 2 cGycm2 and Air
Kerma 44 mgy. 19 ml of contrast were given in total. A total of
450 units of IV heparin were given throughout the case.
There were no complications.
