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Multiple Cardiology Procedures: Cath/renal angiography with balloon angio and stent

  1. #1
    Default Multiple Cardiology Procedures: Cath/renal angiography with balloon angio and stent
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    New to cardiology and I think I'm getting myself overwhelmed when searching for the codes but I want to learn. I know some of these are included in others but still confused, HELP please!

    Procedure Performed:
    1. RT and LT heart Catherization
    2. Aortic valve study
    3. Left ventriculogram
    4. Coronary angiography
    5. Distal abdominal aortography
    6. Selective renal angiography with balloon angioplasty and stent placement with a 5.0x18mm heculink placed in the left renal artery proximal.
    8. Sheath suture in place. Plan for manual pressure, hold 2 hr post procedure
    9. Supervision and interpretation of above.

  2. #2
    Default
    Anyone want to help with this scenario...

  3. Default
    First things you need to know: Is this for a congenital Condition? Are there Bypass Grafts (CABG) present? Assuming none of these are true, this is how I coded it.

    37246-26-LT Angioplasty of an Artery (first):Left Side, and 26 for Professional fees only.)
    93460-26-51 (angioplasty is a separate procedure, but is subject to multiple procedure discounting. With CABG present, we'd use 93461)
    75625-26-59 (Requires 59 because you're doing a procedure on a different site. XS would work too).

    CPT Guidelines: Can't use 93565 unless its with a congenital procedure; 93567 cant use it because CPT guidelines and your documentation point to otherwise. We use the imaging code.

    Quote Originally Posted by michiboo View Post
    New to cardiology and I think I'm getting myself overwhelmed when searching for the codes but I want to learn. I know some of these are included in others but still confused, HELP please!

    Procedure Performed:
    1. RT and LT heart Catherization
    2. Aortic valve study- see more specific line 6
    3. Left ventriculogram-CPT excluded
    4. Coronary angiography-BIL= 93460
    5. Distal abdominal aortography 75625-XS-26
    6. Selective renal angiography with balloon angioplasty and stent placement with a 5.0x18mm heculink placed in the left renal artery proximal. 37246
    8. Sheath suture in place. Plan for manual pressure, hold 2 hr post procedure (included in procedure)
    9. Supervision and interpretation of above.
    (implies modifier 26)

    I hope this helps

    Jack

  4. #4
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    Quote Originally Posted by jacksycz View Post
    First things you need to know: Is this for a congenital Condition? Are there Bypass Grafts (CABG) present? Assuming none of these are true, this is how I coded it.

    37246-26-LT Angioplasty of an Artery (first):Left Side, and 26 for Professional fees only.)
    93460-26-51 (angioplasty is a separate procedure, but is subject to multiple procedure discounting. With CABG present, we'd use 93461)
    75625-26-59 (Requires 59 because you're doing a procedure on a different site. XS would work too).

    CPT Guidelines: Can't use 93565 unless its with a congenital procedure; 93567 cant use it because CPT guidelines and your documentation point to otherwise. We use the imaging code.

    (implies modifier 26)

    I hope this helps

    Jack
    I have to disagree with what you have Jack. With the heart, a right and left heart cath was performed along with a supravalvular aortogram ( if documented). That is coded 93460 and 93657. For the renals, we have selective renal arteriogram, so the abdominal aortogram is bundled in the renal arteriogram code. So 36252-xs or 59 is coded. Then a stent is placed in the Left Renal artery. This will be coded 37236-LT,59. There is not any mention of bypass grafts, so I would not worry about 93461 ( although a full report would have been nice to confirm). Add modifier-26 if your coding for the doctor.

    Thanks,
    Jim Pawloski, CIRCC

  5. #5
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    Quote Originally Posted by Jim Pawloski View Post
    I have to disagree with what you have Jack. With the heart, a right and left heart cath was performed along with a supravalvular aortogram ( if documented). That is coded 93460 and 93657. For the renals, we have selective renal arteriogram, so the abdominal aortogram is bundled in the renal arteriogram code. So 36252-xs or 59 is coded. Then a stent is placed in the Left Renal artery. This will be coded 37236-LT,59. There is not any mention of bypass grafts, so I would not worry about 93461 ( although a full report would have been nice to confirm). Add modifier-26 if your coding for the doctor.

    Thanks,
    Jim Pawloski, CIRCC

    Appreciate the feedback but I have some questions: I have matched the codes next to procedures, now shouldn't the stent be priority? and why 36252 (bilateral)? why 93657? sorry not understanding.



    93460 - 26
    37259 - LT,26,59
    36252 - 26, 59

    Procedure Performed:
    1. RT and LT heart Catherization =93460
    2. Aortic valve study
    3. Left ventriculogram = 93460
    4. Coronary angiography = 93460
    5. Distal abdominal aortography = 36252 -59
    6. Selective renal angiography with balloon angioplasty and stent placement with a 5.0x18mm heculink placed in the left renal artery proximal. = 37236 -LT
    8. Sheath suture in place. Plan for manual pressure, hold 2 hr post procedure
    9. Supervision and interpretation of above.

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