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Thread: Please advise-Help

  1. #1

    Default Please advise-Help

    AAPC: Back to School
    Would you bill the these codes for the following procedure? Please help I am new to cardiology billing


    DESCRIPTION OF PROCEDURE: Following informed consent, the patient was
    brought to the cardiac catheterization laboratory where the right groin was
    prepped and draped in the usual sterile fashion. Xylocaine 8 mL of 1% was
    infiltrated into the right groin for local anesthesia. A 6-French sheath
    was introduced into the right femoral artery upon 1st attempt using the
    modified Seldinger technique. A 6-French JL4 and 6-French JR4 catheters
    were used for selective left and right coronary angiography respectively.
    Subsequently after thorough review of the angiograms, it was decided to
    proceed with an attempt to open the chronic total occlusion of the
    circumflex artery. A 6-French XB3.5 guide catheter was used to cannulate
    the ostium of the left main artery, and after Angiomax administration, a
    0.014 BMW wire was placed at the site of the stenosis. Attempts to cross
    the lesion were unsuccessful. We therefore exchanged to a ChoICE PT wire,
    which as well did not advance into the lesion.
    At this point, given the patient's pre-existing anemia of uncertain
    etiology, and also the significant disease of the RCA which requires
    advanced interventional techniques, it was felt that it was of the patient
    the benefit to abort further interventional techniques; that it was felt
    better to proceed with surgical coronary revascularization as opposed to
    interventional techniques. All catheters were removed; however we 1st
    inserted a pigtail catheter into the left ventricle, where pressure
    measurements were obtained. No cineventriculography was performed in order
    to save contrast dye. All catheters were removed as well as the sheath and
    manual pressure was applied until very good hemostasis was obtained. There
    were no complications during the procedure. The total amount of contrast
    used was 100 mL. Total fluoro time was 11.3 minutes.

    1. Opening aortic pressure is 148/706/103.
    2. Left ventricular pressure at baseline 140/14 with left ventricular
    end-diastolic pressure of 21 mmHg.
    3. Final aortic pressure 145/60 6/96.
    4. There was no significant gradient during pullback of the pigtail
    catheter from the left ventricle into the ascending aorta.

    1. The left main artery has no evidence of significant obstructive disease.

    2. The left anterior descending artery reveals an eccentric proximal 60%
    3. The circumflex artery reveals a 100% lesion. It was attempted to cross
    this lesion with several wires, which proved to be unsuccessful,
    likely suggestive of a chronic total occlusion at this vessel.
    However, distal portions of the obtuse marginal branch of significant
    size are visible.
    4. The right coronary artery has a very proximal origin of the sinoatrial
    branch. It reveals a heavily calcified 80% ostial lesion.
    5. There is a 90% lesion in the mid section. There is diffuse

    RIGHT FEMORAL ANGIOGRAM: The sheath entry point was utilized for
    opacification. There was no significant stenosis.

    CONCLUSIONS: This is a very pleasant male patient who recently experienced
    an acute coronary event. He was found to have significant triple-vessel
    disease with 60% left anterior descending stenosis and 100% circumflex
    stenosis, visualization of distal sections of the circumflex artery and the
    obtuse marginal branches as well as a heavily calcified ostial right
    coronary artery lesion and mid right coronary artery lesion.

  2. #2


    I would just bill the diagnostic cath only. Personally have not had alot of luck getting reimbursed. If the hours in the lab were significant i would bill the cath as usual and then resubmit with documentation why doctor should receive additional reimbursement.


  3. #3


    So I should not bill for the failed PCI (92980-LC-53). Even though it is documented?

  4. #4


    He did pretty good documentation of the cath and the problems he had trying to do the PTCA and why he had to stop the procedure. I would code


    I would code for an attempted/failed PTCA rather than a stent. He stated "it was decided to proceed with an attempt to open the chronic total occlusion of the circumflex artery." No where in the report does it mention stent.

    You will have to send his cath report. They may not pay on the PTCA but they will never pay if you don't submit
    Last edited by sbicknell; 08-27-2010 at 08:22 PM.

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