I work in a combined Cardiac Cath/Interventional Radiology (Angio) Lab and this is what we do: First, the Cardiologist uses a modified Seldinger technique which is how the femoral artery is accessed. This is a single arterial wall puncture (if both walls are puncture it is just a Seldinger technique and you would have bleeding issues, i.e. hematoma). Then a sheath is placed into the artery to allow exchanges of wires, catheters, balloon, stents, etc. If we are doing a typical left heart cath, we use three catheters. One for the left main to look at the Left anterior descending artery and it's branches (diagonals) and the Circumflex and it's branches (obtuse marginals). The second one for the Right coronary artery and it's branches (posterior lateral and perhaps a posterior descending if it comes off the RCA). A third catheter is used for the ventriculargram when it is power injected. In this case we would code for the coronary arteriogram, left heart cath, left ventricular gram, left ventriculargram S&I, and selective S&I. It doesn't matter how many catheters you use to determine the procedures. Sometimes we have to change out catheters to match the anatomy of the patient. That doesn't mean we charge for a separate procedure, only for the extra catheter(s).
For interventions we charge per vessel and not extra for additional branches off the main artery. For example if we stent the LAD and the diagonal we can only charge for stenting the LAD.
Hope this helps and if you have any other questions, please ask.
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