Results 1 to 10 of 10

Cardiac catheterization

  1. #1
    Default Cardiac catheterization
    Medical Coding Books
    Hi All,

    Please confirm my codes for the below procedure.
    93510-26,93543,93555-26,93545,93556-26,75710-26,59,G0269

    BLOOD LOSS:
    About 15-20 mL.

    TOTAL CONTRAST USED:
    151 mL.

    FLUORO TIME:
    12.05 minutes.

    COMPLICATIONS:
    Nil.

    PROCEDURE:
    The procedure was done to the right groin. The patient has had 1 mg of
    Versed as conscious sedation. Under local anesthesia, right femoral artery
    was entered in the first attempt, anterior wall punctured, and 6-French
    arterial sheath was put in. The procedure was done without any
    anticoagulation. The patient was also given Mucomyst before the procedure
    because of mild elevation of serum creatinine level of 1.4.

    Using 6-French left coronary catheter, selective left coronary arteriogram
    was done in multiple views. This catheter was replaced by 6-FR4 diagnostic
    catheter and selective right coronary arteriogram was done in multiple views.
    This catheter was replaced with the pigtail catheter and pigtail catheter
    was advanced into the left ventricle. It produced multiple PVCs because it
    was jumping between the apex and when it is withdrawn it would come out of
    the left ventricle. In the process of getting it into the left ventricle
    again without wire was made and it crossed the loop into the catheter just
    above the sheath. This took quite a bit of time _____ . It seems that the
    closed lumen completely. The guidewire of 0.35 was attempted to pass without
    any success. Then, I tried _____ again without success. Then, I made
    counterclockwise rotation, undid the loop, passed the guidewire, and then
    over the wire the pigtail catheter was removed. This was changed to another
    pigtail catheter and catheter was again advanced into the left ventricle.
    After recording the pressures, the left ventriculogram was done.

    Catheter and the wires were removed. Right femoral arteriogram was done.
    Angio-Seal was deployed. The patient tolerated the procedure well.

    INTERPRETATION:
    1. LEFT HEART CARDIAC CATHETERIZATION. THE LV PRESSURE WAS 128/14 AND
    DIASTOLIC PRESSURE 19 MMHG. AORTIC PRESSURE GRADIENT WAS 150/28 WITH MEAN OF
    85, BUT THIS IS OF COURSE BECAUSE OF OVERSHOOT. THERE WAS NO GRADIENT ACROSS
    THE AORTIC VALVE.
    2. CORONARY ARTERIOGRAM.
    A. LEFT MAIN CORONARY ARTERY 4.25 MM IN DIAMETER, LESS THAN 10% LESION
    DISTALLY.
    B. LAD HAS A STENT PROXIMALLY. IT IS PATENT. REST OF THE LAD AND ITS D1
    BRANCH, WHICH IS 1.75 MM DIAMETER, PATENT. LAD ITSELF IS 3.25 MM IN
    DIAMETER.
    C. CIRCUMFLEX. THIS ALSO HAS A STENT PROXIMALLY. IT IS A 2.25 TO 2.5 MM
    VESSEL. IT GIVES INTO HIGH OM BRANCH, WHICH CAN ALSO BE CONSIDERED AS
    INTERMEDIUS. OTHER BRANCHES OM2 AND OM3 ARE PATENT. NO LESIONS.
    D. RCA IS A 4 MM VESSEL, HAS A STENT PROXIMALLY. THERE IS NO STENOSIS AND
    THERE IS NO LESION IN THE RCA OR ITS BRANCHES LV POSTERIOR BRANCH AND THE PDA
    BRANCH. THERE ARE NO COLLATERALS.
    3. RIGHT FEMORAL ARTERIOGRAM. THE PUNCTURE IS ABOVE THE BIFURCATION AND
    THERE IS NO LESION OR ANY LEAK. THE PATIENT TOLERATED THE PROCEDURE WELL.

    CONCLUSIONS:
    This is an essentially normal study in terms of having no hemodynamic
    lesions. All the stents are patent.

    Thanks,
    JRC, CPC

  2. #2

  3. #3
    Default
    Quote Originally Posted by JRC View Post
    Hi All,

    Please confirm my codes for the below procedure.
    93510-26,93543,93555-26,93545,93556-26,75710-26,59,G0269

    BLOOD LOSS:
    About 15-20 mL.

    TOTAL CONTRAST USED:
    151 mL.

    FLUORO TIME:
    12.05 minutes.

    COMPLICATIONS:
    Nil.

    PROCEDURE:
    The procedure was done to the right groin. The patient has had 1 mg of
    Versed as conscious sedation. Under local anesthesia, right femoral artery
    was entered in the first attempt, anterior wall punctured, and 6-French
    arterial sheath was put in. The procedure was done without any
    anticoagulation. The patient was also given Mucomyst before the procedure
    because of mild elevation of serum creatinine level of 1.4.

    Using 6-French left coronary catheter, selective left coronary arteriogram
    was done in multiple views. This catheter was replaced by 6-FR4 diagnostic
    catheter and selective right coronary arteriogram was done in multiple views.
    This catheter was replaced with the pigtail catheter and pigtail catheter
    was advanced into the left ventricle. It produced multiple PVCs because it
    was jumping between the apex and when it is withdrawn it would come out of
    the left ventricle. In the process of getting it into the left ventricle
    again without wire was made and it crossed the loop into the catheter just
    above the sheath. This took quite a bit of time _____ . It seems that the
    closed lumen completely. The guidewire of 0.35 was attempted to pass without
    any success. Then, I tried _____ again without success. Then, I made
    counterclockwise rotation, undid the loop, passed the guidewire, and then
    over the wire the pigtail catheter was removed. This was changed to another
    pigtail catheter and catheter was again advanced into the left ventricle.
    After recording the pressures, the left ventriculogram was done.

    Catheter and the wires were removed. Right femoral arteriogram was done.
    Angio-Seal was deployed. The patient tolerated the procedure well.

    INTERPRETATION:
    1. LEFT HEART CARDIAC CATHETERIZATION. THE LV PRESSURE WAS 128/14 AND
    DIASTOLIC PRESSURE 19 MMHG. AORTIC PRESSURE GRADIENT WAS 150/28 WITH MEAN OF
    85, BUT THIS IS OF COURSE BECAUSE OF OVERSHOOT. THERE WAS NO GRADIENT ACROSS
    THE AORTIC VALVE.
    2. CORONARY ARTERIOGRAM.
    A. LEFT MAIN CORONARY ARTERY 4.25 MM IN DIAMETER, LESS THAN 10% LESION
    DISTALLY.
    B. LAD HAS A STENT PROXIMALLY. IT IS PATENT. REST OF THE LAD AND ITS D1
    BRANCH, WHICH IS 1.75 MM DIAMETER, PATENT. LAD ITSELF IS 3.25 MM IN
    DIAMETER.
    C. CIRCUMFLEX. THIS ALSO HAS A STENT PROXIMALLY. IT IS A 2.25 TO 2.5 MM
    VESSEL. IT GIVES INTO HIGH OM BRANCH, WHICH CAN ALSO BE CONSIDERED AS
    INTERMEDIUS. OTHER BRANCHES OM2 AND OM3 ARE PATENT. NO LESIONS.
    D. RCA IS A 4 MM VESSEL, HAS A STENT PROXIMALLY. THERE IS NO STENOSIS AND
    THERE IS NO LESION IN THE RCA OR ITS BRANCHES LV POSTERIOR BRANCH AND THE PDA
    BRANCH. THERE ARE NO COLLATERALS.
    3. RIGHT FEMORAL ARTERIOGRAM. THE PUNCTURE IS ABOVE THE BIFURCATION AND
    THERE IS NO LESION OR ANY LEAK. THE PATIENT TOLERATED THE PROCEDURE WELL.

    CONCLUSIONS:
    This is an essentially normal study in terms of having no hemodynamic
    lesions. All the stents are patent.

    Thanks,
    JRC, CPC
    I agree with the heart cath codes, but the 75710 cannot be coded since 1) the femoral injection is part of the closure device code and 2) the report does not describe the full extremity.

  4. #4
    Default
    Thank you

    JRC CPC

  5. #5
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    You should not code the 75710. Evaluation of the access site is necessary for the procedure and should not be separately billed, w/wo closure device.
    HTH
    Danny L. Peoples
    CIRCC,CPC

  6. Default
    I agree with the other coders, you cannot bill for 75710 or G0269. Both are bundled with the heart cath.

    Dolores, CPC-CCC

  7. #7
    Default
    Quote Originally Posted by deeva456 View Post
    I agree with the other coders, you cannot bill for 75710 or G0269. Both are bundled with the heart cath.

    Dolores, CPC-CCC
    Sorry to disagree with you, but G0269 is used for closure device use as in angioseal, vasoseal, perclose or other devices.

    Thanks,
    Jim

  8. #8
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by Jim Pawloski View Post
    Sorry to disagree with you, but G0269 is used for closure device use as in angioseal, vasoseal, perclose or other devices.

    Thanks,
    Jim
    It may be appropriate IMHO, to report the closure device for the facility billing (hospital supplies), and for tracking purposes. It should not be billed for the professional component of the service as the payment for closure is built into the payment for the service, ie no additional payment is made. (per CCI)

    HTH
    Danny L. Peoples
    CIRCC,CPC

  9. #9
    Default
    Quote Originally Posted by dpeoples View Post
    It may be appropriate IMHO, to report the closure device for the facility billing (hospital supplies), and for tracking purposes. It should not be billed for the professional component of the service as the payment for closure is built into the payment for the service, ie no additional payment is made. (per CCI)

    HTH
    I agree with you on that. I just disagreed with the comment that the g-code was bundeled with the procedure.
    Have a great holiday weekend!!!!
    Jim Pawloski

  10. Default Cath lab supplies
    I'm new to hospital billing. What supplies are included in the facility charge for a heart cath? Or maybe an easier question - are any supplies separately payable for a heart cath - if so which ones. I'm getting bills for guidewire, transducer, custom cath lab kit, etc.

    Thanks,
    Helen, CPC

Similar Threads

  1. Help...Cardiac Catheterization
    By Goyard71 in forum Cardiology
    Replies: 2
    Last Post: 08-13-2013, 09:43 PM
  2. Cardiac catheterization
    By PLITTLE in forum Cardiology
    Replies: 2
    Last Post: 02-19-2013, 11:28 AM
  3. Cardiac catheterization
    By ruhood in forum Cardiology
    Replies: 3
    Last Post: 11-18-2009, 01:29 PM
  4. Cardiac catheterization
    By JRC in forum Cardiology
    Replies: 0
    Last Post: 08-21-2009, 03:29 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.