Rt radial artery cath

mvn912

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Hello everyone,

What cpt code would you use for the follwowing procedures.

LHC (via Rt radial approach)
Selective Rt common illiac artery cath (via Rt radial approach)
Selective Rt radial artery cath angiography

I code for physician side so I have
93458-26 for LHC (via Rt radial approach)
36140 for Selective Rt common illiac artery cath (via Rt radial approach)
36140-59 for Selective Rt radial artery cath angiography ??

Any suggestion is really appreciate.
 

mvn912

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Pt was brought to the cardiac cath lab. The right upper extremity was prepped and draped in usual sterile fashion. Allen's test was performed and was confirmed to be negative. The right radial pulse was not palpated. The pt was given 2mg of ….Lidocaine 5ml was then administered locally in the right radial area.
A micropuncture kit was then used to obtain access in the right radial artery of note, and multiple attempts were made to obtain successful cannulation of the rt radial artery. A 6French arterial sheath was placed in the rt radial artery.A radial cocktail consisting of heparin….were then administered. Of note, initially we had decreased to no flow from the sheath. However, after multiple manipulations we were able to achieve back flow from the right radial sheath.
Selective coronary angiography, LHC, LV Angiography: A 5-French was used to selectively engage the Lt and Rt coronary arteries. The catheter was also used to cross the aortic valve and perform LHC, LV angiography. Findings were as follows:
1. LV ejection fraction is 60%. LVEDP is noted to be 8 mmHg, normal LV systolic function
2. The Left main coronary artery is large caliber vessel, angiographically normal
3. Left circumflex is a large caliber vessel,give rise to 2 large OM and is disease free.
4. LAD is large caliber vessel and is disease free
5. Rt coronary artery is a medium caliber vessel
Selective RIGHT common iliac artery catheterization and angiography: 5-french angled tip Glide catheter was then used to navigate the abdominal aorta via the right radial approach. The tip of the cath was placed in the rt common iliac artery. Rt common iliac artey catheterization with run off was performed. Findings: Rt common iliac, ext and internal iliac, Rt SFA, rt profunda femoral art, rt posterior and anterior tibial are patent and free of disease.
Selective LEFT external iliac artery catheterization and angiography via rt radial approach: a 120cm Glide catheter was used to engage the Lt external iliac art. Catheterization selective angiography was performed. Findings: Lt internal, external iliac, common femoral, profunda femoral, SFA, popliteal, posterial, anterial tibial are widely patent.
At this point, the catheter was then removed.
The shealth was then flushed however we once again had difficulty and did not have any backflow from the right radial sheath. At this point, once again the wire was then introduced through the sheath. A 6French Glide catheter was then introduced under fluoroscopy, catheter was placed in the right brachial artery and selective right radial artery catheterization was performed. Initial angiography showed diffuse vasospasm throughout the right radial artery. Then, 100mcg of nitroglycerin was administered and repeat angiography was performed. After excellent blood return was noted, the sheath was then removed and a TR band was placed on the arteriotomy site.
Impression:
1. Normal LV systolic function
2. Normal LV diastolic function
3. Normal coronary arteriography
4. The named arteries of the lower ext are patent and free of disease.
 

mvn912

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here are what I code
93458-26
36246-Lt
36140-Rt
75716-26-59
once again 36140-59 (for selective right radial artery catheterization angiography)????
I am not sure about the last code.

Could anyone help me out?
Thanks a lot
 

Cyndi113

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You cannot bill for the right radial puncture as this is global to the LHC. Your other codes appear to be correct.
 

mvn912

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At the end, the Doc stated that "catheter was placed in the right brachial artery and selective right radial artery catheterization was performed. Initial angiography showed diffuse vasospasm throughout the right radial artery"

Are we be able to code this part too? If yes, what would you code?

Thank you
 
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