Description of procedure:
Pt brought to cath lab, shath placed in RFA, then another sheath placed in R femoral vein. Then swan Ganz cath was advanced through the venous sheath under flouroscopic guidance to pulmonary arter. Pressure measurements were recorded in R. atrium, ventricll,pulmonary capillary wedge positon and RCA. A cath was then advanced through arterial sheath over a wire to AA. After confirming of central arterial pressure, cath was advanced retrograde fashion across AV for measurement of LV pressures. Blood was drawn from LV, RA and pulmonary artery for measurement of oxygen saturations. Cardiac output was measured by thermodilution. L. ventriculography was performes. R. heat pullback was then performed and Swan Ganz cath was removed. Pigtail was w/drawn across the valve for pullback determination fo LV and Aortic pressures. Pigtail caht was exchanged for JL4 cath which was engaged in ostium of LM coronary arter. Selective coronary angiography was performed in multiple views. L cath was exchanged for 6 French JR4 cath which was engaged in the ostium of RCA. Selective coronary angiography was performed in multiple views. The right cath was then withdrawn to AA and placed in the ostium of L renal arter. Selective coronary angiography was performed. The cath was then repositioned in ostium of R renal artery and selective coronary angiography was performed. The cath was removed.
Billed: 93460 26.59, 36245 RT, 36245 LT, and 36252.59...... Mcare pd 93460, 36252, but denied 36245 RT, 36245 LT stating B15, service requires qualifying service/procedure.....
Any suggestions?
Pt brought to cath lab, shath placed in RFA, then another sheath placed in R femoral vein. Then swan Ganz cath was advanced through the venous sheath under flouroscopic guidance to pulmonary arter. Pressure measurements were recorded in R. atrium, ventricll,pulmonary capillary wedge positon and RCA. A cath was then advanced through arterial sheath over a wire to AA. After confirming of central arterial pressure, cath was advanced retrograde fashion across AV for measurement of LV pressures. Blood was drawn from LV, RA and pulmonary artery for measurement of oxygen saturations. Cardiac output was measured by thermodilution. L. ventriculography was performes. R. heat pullback was then performed and Swan Ganz cath was removed. Pigtail was w/drawn across the valve for pullback determination fo LV and Aortic pressures. Pigtail caht was exchanged for JL4 cath which was engaged in ostium of LM coronary arter. Selective coronary angiography was performed in multiple views. L cath was exchanged for 6 French JR4 cath which was engaged in the ostium of RCA. Selective coronary angiography was performed in multiple views. The right cath was then withdrawn to AA and placed in the ostium of L renal arter. Selective coronary angiography was performed. The cath was then repositioned in ostium of R renal artery and selective coronary angiography was performed. The cath was removed.
Billed: 93460 26.59, 36245 RT, 36245 LT, and 36252.59...... Mcare pd 93460, 36252, but denied 36245 RT, 36245 LT stating B15, service requires qualifying service/procedure.....
Any suggestions?
