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Help - Left Heart Cath coding

  1. Default Help - Left Heart Cath coding
    Exam Training Packages
    I am new to hospital billing can some one please help me code the following procedure:

    Left heart catheterization.
    2. Coronary angiography.
    3. Saphenous vein graft angiography.
    4. Left internal mammary artery angiography.

    CONCLUSION: Two-vessel coronary artery disease with 3 grafts patent.
    1. Left main: Normal.
    2. Left anterior descending: Mild disease.
    3. Circumflex: 70% proximal to mid disease.
    4. Obtuse marginal 1: 100% occluded and distal obtuse marginal occluded.
    5. Right coronary artery: 100% proximal occlusion.
    6. Left internal mammary artery is ungrafted.
    7. Saphenous vein graft to obtuse marginal is patent.
    8. Saphenous vein graft to posterior descending artery and distal circumflex patent.
    9. No left ventriculogram.

    PLAN: Medical therapy.

    HISTORY: The patient is a 76-year-old gentleman with a history of
    bypass surgery in 2000 with recurrent chest pain and known renal
    insufficiency. The patient was taken to the cath lab.
    DESCRIPTION OF PROCEDURE: Informed consent was obtained from the
    patient. The patient was premedicated and brought to the cath lab
    where he was sterilely prepared, draped and locally anesthetized. The
    right femoral artery was cannulated using the Seldinger technique,
    and a 6-French Hemaquet sheath was inserted. Thereafter, bilateral
    angiography, aortography, LIMA angiography and SVG angiography were
    performed. The procedure was tolerated without any complications.
    Thereafter, a StarClose device was deployed.

    LEFT VENTRICULOGRAM: Left ventriculogram was not performed due to
    renal insufficiency.

    CORONARY ANGIOGRAM: Left main: Normal

    LAD: The left anterior descending artery is a medium-sized vessel and
    courses around the apex. There is no evidence of disease.

    Circumflex: The left circumflex artery is a medium-sized vessel. There is 70% proximal and mid disease. Obtuse marginal 1 is 100%
    occluded.

    RCA: The right coronary artery is a medium-sized vessel. There is 100% proximal occlusion.

    LIMA is ungrafted.

    SVG to OM 1 is patent. SVG to PDA/distal circumflex probable sequential graft is patent.

  2. #2
    Default
    Quote Originally Posted by peeya View Post
    I am new to hospital billing can some one please help me code the following procedure:

    Left heart catheterization.
    2. Coronary angiography.
    3. Saphenous vein graft angiography.
    4. Left internal mammary artery angiography.

    CONCLUSION: Two-vessel coronary artery disease with 3 grafts patent.
    1. Left main: Normal.
    2. Left anterior descending: Mild disease.
    3. Circumflex: 70% proximal to mid disease.
    4. Obtuse marginal 1: 100% occluded and distal obtuse marginal occluded.
    5. Right coronary artery: 100% proximal occlusion.
    6. Left internal mammary artery is ungrafted.
    7. Saphenous vein graft to obtuse marginal is patent.
    8. Saphenous vein graft to posterior descending artery and distal circumflex patent.
    9. No left ventriculogram.

    PLAN: Medical therapy.

    HISTORY: The patient is a 76-year-old gentleman with a history of
    bypass surgery in 2000 with recurrent chest pain and known renal
    insufficiency. The patient was taken to the cath lab.
    DESCRIPTION OF PROCEDURE: Informed consent was obtained from the
    patient. The patient was premedicated and brought to the cath lab
    where he was sterilely prepared, draped and locally anesthetized. The
    right femoral artery was cannulated using the Seldinger technique,
    and a 6-French Hemaquet sheath was inserted. Thereafter, bilateral
    angiography, aortography, LIMA angiography and SVG angiography were
    performed. The procedure was tolerated without any complications.
    Thereafter, a StarClose device was deployed.

    LEFT VENTRICULOGRAM: Left ventriculogram was not performed due to
    renal insufficiency.

    CORONARY ANGIOGRAM: Left main: Normal

    LAD: The left anterior descending artery is a medium-sized vessel and
    courses around the apex. There is no evidence of disease.

    Circumflex: The left circumflex artery is a medium-sized vessel. There is 70% proximal and mid disease. Obtuse marginal 1 is 100%
    occluded.

    RCA: The right coronary artery is a medium-sized vessel. There is 100% proximal occlusion.

    LIMA is ungrafted.

    SVG to OM 1 is patent. SVG to PDA/distal circumflex probable sequential graft is patent.

    Try this;
    93510- If pressures were taken. Otherwise 93508.
    93539- Lima
    93540 -Grafts
    93445 - Coronaries
    93556 - S&I Coronaries

    HTH,
    Jim Pawloski, CIRCC

  3. Default
    Quote Originally Posted by Jim Pawloski View Post
    Try this;
    93510- If pressures were taken. Otherwise 93508.
    93539- Lima
    93540 -Grafts
    93445 - Coronaries
    93556 - S&I Coronaries

    HTH,
    Jim Pawloski, CIRCC
    I'm pretty sure Jim meant 93545, not 93445

  4. Default can you use 36246
    If they are doing a LT heart cath and they access the Rt Com Fem artery can you bill the 36246?

  5. #5
    Default
    Quote Originally Posted by adennis View Post
    If they are doing a LT heart cath and they access the Rt Com Fem artery can you bill the 36246?
    No you cannot. It is part of the Left heart cath. Also 36246 is a second order selective below the diaphram.

    HTH,
    Jim Pawloski, CIRCC

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