Our practice specialty is Pulmonary. However, I have a physician that is now doing R. Heart Caths w/ Swan-Ganz. I am not 100% sure how to code the following notes. She did the procedure at the hospital. Should I bill 93501/26(R. Ht. Cath)? Or should I bill 93503(Swan Ganz)? Looking at the CCIs it looks like I can't bill both unless I have a different diagnosis to use then I would use modifier 59 to override the edit. In what instance would it be ok to bill both? (e.g, In what situation would there be a different diagnosis)? She also did an ultrasound during this procedure. Would I bill for that as well?
Here is the OP note:
PROCEDURE: Right heart catheterization.
PREOPERATIVE DIAGNOSIS: Pulmonary hypertension.
POSTOPERATIVE DIAGNOSES:
1. Normal pulmonary artery pressures.
2. High output state.
DESCRIPTION OF PROCEDURE: Informed consent was obtained and placed in the chart. The right neck was prepped with ChloraPrep and draped in the usual manner. Xylocaine, 2%, was used to anesthetize the right neck. The internal jugular vein was accessed with micropuncture needle under direct ultrasound guidance. Dark nonpulsatile blood was obtained. A J-wire was advanced without difficulty. A 7-French sheath was inserted into the right jugular vein. At that time, an Edwards Swan-Ganz catheter was inserted for a right heart catheterization and pressure measurements were obtained. Right atrial pressure was 12/6 with a mean of 6 mmHg, right ventricle was 23/2 with a mean of 6 mmHg, pulmonary artery pressure showed a pulmonary artery systolic pressure of 20 and a pulmonary artery diastolic pressure of 13 with a mean pulmonary artery pressure of 16 mmHg. The mean capillary wedge pressure was 9 mmHg. At that point, thermodilution cardiac output was obtained. Cardiac output was 12 liters per minute given a cardiac index of 6 liters per minute per meter squared. Pulmonary vascular resistance was normal at 47 dynes. Oximetries were obtained with a pulmonary artery saturation of 85%, a right ventricular saturation of 83%, a right atrial saturation of 85%. At that point, the pulmonary artery catheter was removed. The sheath was removed and manual pressure was held until homeostasis was achieved. No oozing or hematoma was noted. The patient tolerated the procedure well without any complications. The patient was transported to recovery in stable condition.
ASSESSMENTS:
1. Normal pulmonary artery pressures.
2. Normal pulmonary vascular resistance, elevated cardiac output, elevated oxygen saturations consistent with a high-output state.
Here is the US note:
NAME OF PROCEDURE: Ultrasound-guided for placement of 7-French catheter sheath in the right internal jugular vein.
DESCRIPTION OF PROCEDURE: Informed consent was obtained and placed them in the chart. The patient was prepped and draped in usual fashion. The right neck was prepped with ________ and draped in the usual manner. A 2% Xylocaine was administered to the right neck for anesthesia. The right internal jugular vein was accessed with a micropuncture needle under direct ultrasound-guided. A dark ________ was obtained. The J-wire was advanced without difficulty. A 7-French sheath was inserted into the right jugular vein. At that time, Swan-Ganz catheter was inserted and pressure measurements were obtained.
Thank you ahead of time for your expertise on this matter.
April
Here is the OP note:
PROCEDURE: Right heart catheterization.
PREOPERATIVE DIAGNOSIS: Pulmonary hypertension.
POSTOPERATIVE DIAGNOSES:
1. Normal pulmonary artery pressures.
2. High output state.
DESCRIPTION OF PROCEDURE: Informed consent was obtained and placed in the chart. The right neck was prepped with ChloraPrep and draped in the usual manner. Xylocaine, 2%, was used to anesthetize the right neck. The internal jugular vein was accessed with micropuncture needle under direct ultrasound guidance. Dark nonpulsatile blood was obtained. A J-wire was advanced without difficulty. A 7-French sheath was inserted into the right jugular vein. At that time, an Edwards Swan-Ganz catheter was inserted for a right heart catheterization and pressure measurements were obtained. Right atrial pressure was 12/6 with a mean of 6 mmHg, right ventricle was 23/2 with a mean of 6 mmHg, pulmonary artery pressure showed a pulmonary artery systolic pressure of 20 and a pulmonary artery diastolic pressure of 13 with a mean pulmonary artery pressure of 16 mmHg. The mean capillary wedge pressure was 9 mmHg. At that point, thermodilution cardiac output was obtained. Cardiac output was 12 liters per minute given a cardiac index of 6 liters per minute per meter squared. Pulmonary vascular resistance was normal at 47 dynes. Oximetries were obtained with a pulmonary artery saturation of 85%, a right ventricular saturation of 83%, a right atrial saturation of 85%. At that point, the pulmonary artery catheter was removed. The sheath was removed and manual pressure was held until homeostasis was achieved. No oozing or hematoma was noted. The patient tolerated the procedure well without any complications. The patient was transported to recovery in stable condition.
ASSESSMENTS:
1. Normal pulmonary artery pressures.
2. Normal pulmonary vascular resistance, elevated cardiac output, elevated oxygen saturations consistent with a high-output state.
Here is the US note:
NAME OF PROCEDURE: Ultrasound-guided for placement of 7-French catheter sheath in the right internal jugular vein.
DESCRIPTION OF PROCEDURE: Informed consent was obtained and placed them in the chart. The patient was prepped and draped in usual fashion. The right neck was prepped with ________ and draped in the usual manner. A 2% Xylocaine was administered to the right neck for anesthesia. The right internal jugular vein was accessed with a micropuncture needle under direct ultrasound-guided. A dark ________ was obtained. The J-wire was advanced without difficulty. A 7-French sheath was inserted into the right jugular vein. At that time, Swan-Ganz catheter was inserted and pressure measurements were obtained.
Thank you ahead of time for your expertise on this matter.
April