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should i code for ptca also?

  1. #1
    Default should i code for ptca also?
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    Conclusion

    This patient with prior treatment for coronary artery disease status post PCI to left circumflex, OM1, OM 2 in 2005, hypertension, dyslipidemia is having symptoms of exertional angina. He also had a abnormal stress test revealing inferolateral ischemia. Left heart catheterization was recommended.
    *
    After obtaining informed consent, the patient was prepped and draped in sterile fashion. A 6 French glide sheath was inserted in the right radial artery. Radial cocktail consisting of 2.5 mg of verapamil and 200 mcg of nitroglycerin was administered via right radial artery sheath to prevent radial artery spasm. A 6 French Judkins left and right coronary catheters was used for left and right coronary angiography. TR band was placed on right radial artery access site for patent hemostasis.
    *
    I attest that moderate conscious sedation was provided under my direct supervision with the sedation trained nurse using 1 mg of intravenous Versed and 50 mcg of fentanyl to sedate the patient. Start time 11:57 AM and end time was 12:40 PM. There were no complications. See nurse's sedation sheet, for complete pre-and post service details.
    *
    Hemodynamics:
    *
    The left ventricular end-diastolic pressure was 19 mmHg. The aortic pressure was 114/61 mmHg.
    *
    Coronary Angiography:
    *
    Right coronary artery is a small nondominant artery with severe diffuse disease.
    *
    Left Main coronary artery is patent.
    *
    Left anterior descending is a medium to large caliber vessel with proximal 20-30% tubular disease at the bifurcation of diagonal 1, mild mid to distal luminal irregularities. Diagonal 1 and diagonal 2 are small caliber vessels with luminal irregularities.
    *
    Left circumflex is a large caliber dominant vessel with patent proximal stent with mild to moderate ISR, moderate mid vessel disease and distal luminal irregularities. Obtuse marginal 1 has subtotal occlusion at the ostium with TIMI III flow in the mid to distal vessel. This was likely jailed during OM 2 stent deployment. Obtuse marginal 2 has severe 99% in-stent restenosis extending into the distal vessel. LPDA and LPL have mild luminal irregularities.
    *
    Left ventriculogram: Left ventricular cavity was entered using guide catheter and LVEDP was measured at 19 mmHg.
    *
    The patient was then transferred to the recovery area in stable condition:
    *
    Summary conclusion:
    *
    1. Coronary disease status post PCI in 2005
    2. Abnormal nuclear stress test
    3. Angina
    4. Hypertension
    5. Dyslipidemia
    *
    Recommendation:
    *
    Recommend PCI of left circumflex/OM 2 due to evidence of inferolateral ischemia and a dominant circumflex territory.
    *
    6 French XB 3.5 guide was used to engage left coronary system. Run-through wire was advanced into distal OM 2. A second run through wire was used as a buddy wire and advanced into distal left circumflex. Lesion was predilated using a 2.5 x 15 mm noncompliant balloon. Promus 2.5 x 32 mm stent deployed from left circumflex into OM 2 and postdilated up to 3.0 mm with stent balloon. Post stent deployment there was pinching of true circumflex. Run-through wire was withdrawn and readvanced through the stent struts and left circumflex was unrevealed using a 2.0 x 12 mm semi-compliant balloon. Postprocedure angiography revealed TIMI-3 flow without any evidence of dissection or perforation.
    *
    Aspirin and Plavix for at least 12 months. Aggressive lipid control management.


    Results

    Contrast Administered (mL):
    Implants

    SYSTEM CORONARY STENT 2.5MM 32MM PROMUS PREMIER MONORAIL EVEROLIMUS PLATINUM CHROMIUM RADIOPAQUE 1 ACCESS PORT BALLOON EXPAND INFLATE LUMEN 144CM ACCEPTS .014- IN GUIDEWIRE - S08714729844952 - LOG337003

    Inventory item: SYSTEM CORONARY STENT 2.5MM 32MM PROMUS PREMIER MONORAIL EVEROLIMUS PLATINUM CHROMIUM RADIOPAQUE 1 ACCESS PORT BALLOON EXPAND INFLATE LUMEN 144CM ACCEPTS .014- IN GUIDEWIRE Serial no.: 08714729844952 Model/Cat no.: H7493952832250
    Implant name: SYSTEM CORONARY STENT 2.5MM 32MM PROMUS PREMIER MONORAIL EVEROLIMUS PLATINUM CHROMIUM RADIOPAQUE 1 ACCESS PORT BALLOON EXPAND INFLATE LUMEN 144CM ACCEPTS .014- IN GUIDEWIRE - S08714729844952 - LOG337003 Laterality: N/A Area: Coronary
    Manufacturer: Boston Scientific Corp Action: Implanted Number used: 1


    thank you in advance
    my question is 93458-xu, c9600-lc should I also do 92920 lc? physician wants to add for his time
    *

  2. Default
    where is the procedure note???

  3. Default
    As per the document I cannot see angiography being performed in a different vessel as placement of drug eluting stents. Hence code C9600 includes/bundles the angiography procedure. Need not to bill separately.

  4. #4
    Default
    Quote Originally Posted by bhargavi View Post
    Conclusion

    This patient with prior treatment for coronary artery disease status post PCI to left circumflex, OM1, OM 2 in 2005, hypertension, dyslipidemia is having symptoms of exertional angina. He also had a abnormal stress test revealing inferolateral ischemia. Left heart catheterization was recommended.
    *
    After obtaining informed consent, the patient was prepped and draped in sterile fashion. A 6 French glide sheath was inserted in the right radial artery. Radial cocktail consisting of 2.5 mg of verapamil and 200 mcg of nitroglycerin was administered via right radial artery sheath to prevent radial artery spasm. A 6 French Judkins left and right coronary catheters was used for left and right coronary angiography. TR band was placed on right radial artery access site for patent hemostasis.
    *
    I attest that moderate conscious sedation was provided under my direct supervision with the sedation trained nurse using 1 mg of intravenous Versed and 50 mcg of fentanyl to sedate the patient. Start time 11:57 AM and end time was 12:40 PM. There were no complications. See nurse's sedation sheet, for complete pre-and post service details.
    *
    Hemodynamics:
    *
    The left ventricular end-diastolic pressure was 19 mmHg. The aortic pressure was 114/61 mmHg.
    *
    Coronary Angiography:
    *
    Right coronary artery is a small nondominant artery with severe diffuse disease.
    *
    Left Main coronary artery is patent.
    *
    Left anterior descending is a medium to large caliber vessel with proximal 20-30% tubular disease at the bifurcation of diagonal 1, mild mid to distal luminal irregularities. Diagonal 1 and diagonal 2 are small caliber vessels with luminal irregularities.
    *
    Left circumflex is a large caliber dominant vessel with patent proximal stent with mild to moderate ISR, moderate mid vessel disease and distal luminal irregularities. Obtuse marginal 1 has subtotal occlusion at the ostium with TIMI III flow in the mid to distal vessel. This was likely jailed during OM 2 stent deployment. Obtuse marginal 2 has severe 99% in-stent restenosis extending into the distal vessel. LPDA and LPL have mild luminal irregularities.
    *
    Left ventriculogram: Left ventricular cavity was entered using guide catheter and LVEDP was measured at 19 mmHg.
    *
    The patient was then transferred to the recovery area in stable condition:
    *
    Summary conclusion:
    *
    1. Coronary disease status post PCI in 2005
    2. Abnormal nuclear stress test
    3. Angina
    4. Hypertension
    5. Dyslipidemia
    *
    Recommendation:
    *
    Recommend PCI of left circumflex/OM 2 due to evidence of inferolateral ischemia and a dominant circumflex territory.
    *
    6 French XB 3.5 guide was used to engage left coronary system. Run-through wire was advanced into distal OM 2. A second run through wire was used as a buddy wire and advanced into distal left circumflex. Lesion was predilated using a 2.5 x 15 mm noncompliant balloon. Promus 2.5 x 32 mm stent deployed from left circumflex into OM 2 and postdilated up to 3.0 mm with stent balloon. Post stent deployment there was pinching of true circumflex. Run-through wire was withdrawn and readvanced through the stent struts and left circumflex was unrevealed using a 2.0 x 12 mm semi-compliant balloon. Postprocedure angiography revealed TIMI-3 flow without any evidence of dissection or perforation.
    *
    Aspirin and Plavix for at least 12 months. Aggressive lipid control management.


    Results

    Contrast Administered (mL):
    Implants

    SYSTEM CORONARY STENT 2.5MM 32MM PROMUS PREMIER MONORAIL EVEROLIMUS PLATINUM CHROMIUM RADIOPAQUE 1 ACCESS PORT BALLOON EXPAND INFLATE LUMEN 144CM ACCEPTS .014- IN GUIDEWIRE - S08714729844952 - LOG337003

    Inventory item: SYSTEM CORONARY STENT 2.5MM 32MM PROMUS PREMIER MONORAIL EVEROLIMUS PLATINUM CHROMIUM RADIOPAQUE 1 ACCESS PORT BALLOON EXPAND INFLATE LUMEN 144CM ACCEPTS .014- IN GUIDEWIRE Serial no.: 08714729844952 Model/Cat no.: H7493952832250
    Implant name: SYSTEM CORONARY STENT 2.5MM 32MM PROMUS PREMIER MONORAIL EVEROLIMUS PLATINUM CHROMIUM RADIOPAQUE 1 ACCESS PORT BALLOON EXPAND INFLATE LUMEN 144CM ACCEPTS .014- IN GUIDEWIRE - S08714729844952 - LOG337003 Laterality: N/A Area: Coronary
    Manufacturer: Boston Scientific Corp Action: Implanted Number used: 1


    thank you in advance
    my question is 93458-xu, c9600-lc should I also do 92920 lc? physician wants to add for his time
    *
    I would bill 93454-XU as the states what the LVEDP is, he didn't state that a catheter entered the LV. Angioplasty is bundled into any stent placement, so you bill C9600-LC. Diagnostic coronary angiography is billable with a stent placement as long as there is not previous cardiac cath.
    HTH,
    Jim Pawloski, CIRCC

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