Wiki Trapped Swan-Ganz catheter

[bennieyoung]

Is there a code for A repeat median sternotomy with cardiopulmonary bypass with removal of Swan-Ganz catheter? When researching I read that I should code a right heart cath but that doesn't seem right to me.

This patient had undergone surgery several days prior with a Swan-Ganz catheter placed. Upon attempts to remove it today, it would not come with gentle retraction and there was suspicion that it was trapped by a suture. He was brought to the operating room, intubated, monitoring lines were connected. He was prepped and draped. Repeat sternotomy was performed. It was apparent that it was trapped in the likely repair suture on the left atrial closure, but I could not be certain that it was not the actual continuous closure suture, so I therefore heparinized the patient, went on bypass temporarily, removed the suture that I thought was the offending suture, and the catheter was easily replaced. That place was oversewn. The patient was weaned from bypass. The heparin was reversed with protamine. Cannula was removed and oversewn. Chest was irrigated. The thymic fat and pericardium were reapproximated. Sternum was closed. The patient was returned to ICU in stable condition

 

[bennieyoung]

When I pull up what the code for this should be it gives me 93503. CPT code is 93503 (Swan-Ganz) is reported when the procedure is done at bedside and the procedure is done for the purposes of hemodynamic monitoring.
I'm looking for "removal" done in the Cath lab. Unfortunately I'm beginning to think this isn't a billable service.

 

[thomas7331]

When I pull up what the code for this should be it gives me 93503. CPT code is 93503 (Swan-Ganz) is reported when the procedure is done at bedside and the procedure is done for the purposes of hemodynamic monitoring.
I'm looking for "removal" done in the Cath lab. Unfortunately I'm beginning to think this isn't a billable service.

I think the fact that it’s a Swan-Ganz catheter is throwing you off here. The surgery you posted above is not a routine removal of a catheter. In this case it is a complication of the device. It’s definitely a billable service. For coding purposes, I would treat this as a sternotomy and exploration with removal of a foreign body, not a catheter removal procedure. I don’t have my book handy so can’t recommend a code, but if there isn’t a specific code to accurately report this work, you’d just have to use an unlisted code.

 

[bennieyoung]

I think the fact that it’s a Swan-Ganz catheter is throwing you off here. The surgery you posted above is not a routine removal of a catheter. In this case it is a complication of the device. It’s definitely a billable service. For coding purposes, I would treat this as a sternotomy and exploration with removal of a foreign body, not a catheter removal procedure. I don’t have my book handy so can’t recommend a code, but if there isn’t a specific code to accurately report this work, you’d just have to use an unlisted code.

Thank you so much! That gives me a direction as to which codes to look at. You are right, I was searching for the Swan-Ganz specifically and was just hitting a wall. It didn't occur to me to do it this way. I really appreciate your help!