calorom2
Networker
I'm not sure if I'm wording this correctly but I'm wondering if there are any key clues to tell me when I can and can't bill LHC with PCI/stent? I've read CPT regarding diagnostic angiography performed at the time of a coronary interventional procedure but am wondering what specifically to look for/any examples. I think I'm just overthinking everything. Should something be jumping out at me to say hey...no 93458-26-59 with 92928-LC?
Here is an example below to use and any help is appreciated!!
PROCEDURE PERFORMED:
Left heart catheterization, coronary angiography, stenting of the marginal
branch of the circumflex.
INDICATIONS:
Chest pain, ischemic cardiomyopathy, class III angina.
DESCRIPTION OF PROCEDURE:
Following Xylocaine anesthesia to the right groin, a 6-French sheath
was placed in the right femoral artery via Seldinger technique. A 6-French
pigtail was advanced to left ventricle and left ventriculogram performed
in the RAO view using 36 mL contrast at 12 mL/second. Pullback across
the aortic valve was recorded. Using a 6-French 4 left Judkins, the
left coronary artery selectively catheterized and cineangiograms were
recorded. Using a 6-French 4 right Judkins, the right coronary artery
selectively catheterized and cineangiograms were recorded. The patient
was given Lovenox 0.75 mg/kg intravenously. A 6-French 3.5 Voda guiding
catheter was positioned in the left coronary artery. An 0.014 BMW wire
advanced to the distal aspect of the marginal branch of the circumflex.
A 2.5 x 12 mm balloon was used to pre-dilate the 90% to 95% stenosis
in the midportion of the marginal branch. A 2.5 x 16 mm Synergy drug-eluting
stent was then positioned across the stenosis with the delivery balloon
inflated to 14 atmospheres for 35 seconds. The patient did not have
chest pain with balloon inflations. The balloon catheter was removed.
Controlled angiogram showed the stent to be fully deployed with no
residual areas of stenosis. Angio-Seal was placed in the right groin.
He was returned to his room in stable condition.
ESTIMATED BLOOD LOSS:
10 mL.
ESTIMATED CONTRAST:
125 mL of Omnipaque 350.
COMPLICATIONS:
None.
HEMODYNAMIC DATA:
Central aortic pressure is 136/69, left ventricular pressure 132/16.
There was no gradient on pullback across the aortic valve.
Left ventriculogram demonstrated a normal-sized left ventricle. It was
diffusely hypokinetic with an ejection fraction estimated at 20% to
25%.
CORONARY ANGIOGRAPHY:
A. The left main coronary artery is normal.
B. The left anterior descending had previously deployed stents in the
proximal portion, which were widely patent. The midportion of the LAD
did have a focal 60% stenosis.
C. The circumflex has been previously stented, though difficult to tell
whether 1 or 2 stents. In the proximal portions, he has 50% to 60%
stenosis. In the midportion of the marginal branch, he had a 90% to
95% stenosis.
D. The right coronary artery had been previously stented. The stents
were patent to the one between and the proximal portion has a 60% stenosis.
Distally, proximal to the posterior descending has a 50% stenosis.
The right coronary artery is a large dominant vessel. No collaterals
were noted.
FINAL DIAGNOSES:
1. Severely diminished left ventricular function as described above.
2. Three-vessel coronary artery disease as described above.
3. Successful stenting in the marginal branch of the circumflex with
90% to 95% stenosis having 0% residual stenosis.
We will again discuss with the patient ICD, though he has declined in
the past. He will otherwise continue medical treatment.
Here is an example below to use and any help is appreciated!!
PROCEDURE PERFORMED:
Left heart catheterization, coronary angiography, stenting of the marginal
branch of the circumflex.
INDICATIONS:
Chest pain, ischemic cardiomyopathy, class III angina.
DESCRIPTION OF PROCEDURE:
Following Xylocaine anesthesia to the right groin, a 6-French sheath
was placed in the right femoral artery via Seldinger technique. A 6-French
pigtail was advanced to left ventricle and left ventriculogram performed
in the RAO view using 36 mL contrast at 12 mL/second. Pullback across
the aortic valve was recorded. Using a 6-French 4 left Judkins, the
left coronary artery selectively catheterized and cineangiograms were
recorded. Using a 6-French 4 right Judkins, the right coronary artery
selectively catheterized and cineangiograms were recorded. The patient
was given Lovenox 0.75 mg/kg intravenously. A 6-French 3.5 Voda guiding
catheter was positioned in the left coronary artery. An 0.014 BMW wire
advanced to the distal aspect of the marginal branch of the circumflex.
A 2.5 x 12 mm balloon was used to pre-dilate the 90% to 95% stenosis
in the midportion of the marginal branch. A 2.5 x 16 mm Synergy drug-eluting
stent was then positioned across the stenosis with the delivery balloon
inflated to 14 atmospheres for 35 seconds. The patient did not have
chest pain with balloon inflations. The balloon catheter was removed.
Controlled angiogram showed the stent to be fully deployed with no
residual areas of stenosis. Angio-Seal was placed in the right groin.
He was returned to his room in stable condition.
ESTIMATED BLOOD LOSS:
10 mL.
ESTIMATED CONTRAST:
125 mL of Omnipaque 350.
COMPLICATIONS:
None.
HEMODYNAMIC DATA:
Central aortic pressure is 136/69, left ventricular pressure 132/16.
There was no gradient on pullback across the aortic valve.
Left ventriculogram demonstrated a normal-sized left ventricle. It was
diffusely hypokinetic with an ejection fraction estimated at 20% to
25%.
CORONARY ANGIOGRAPHY:
A. The left main coronary artery is normal.
B. The left anterior descending had previously deployed stents in the
proximal portion, which were widely patent. The midportion of the LAD
did have a focal 60% stenosis.
C. The circumflex has been previously stented, though difficult to tell
whether 1 or 2 stents. In the proximal portions, he has 50% to 60%
stenosis. In the midportion of the marginal branch, he had a 90% to
95% stenosis.
D. The right coronary artery had been previously stented. The stents
were patent to the one between and the proximal portion has a 60% stenosis.
Distally, proximal to the posterior descending has a 50% stenosis.
The right coronary artery is a large dominant vessel. No collaterals
were noted.
FINAL DIAGNOSES:
1. Severely diminished left ventricular function as described above.
2. Three-vessel coronary artery disease as described above.
3. Successful stenting in the marginal branch of the circumflex with
90% to 95% stenosis having 0% residual stenosis.
We will again discuss with the patient ICD, though he has declined in
the past. He will otherwise continue medical treatment.