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R/LHC with Bilateral Renal Angio

  1. Default R/LHC with Bilateral Renal Angio
    Medical Coding Books
    My physician is coding a R&LHC and bilateral Renal angio for the following, Please advise what codes should be billed. I am not sure if the documentation supports the bilateral renal angio.

    Indication:
    The patient is a 64 year old female who experienced flash pulmonary edema? as well as a non-STEMI was a troponin of 1.

    Procedures:
    1. Left Heart Cath with selective coronary angiography
    2. Left ventriculogram
    3. Right heart cath
    4. Abdominal flush.

    The patient was prepped and draped in sterile fashion. Access was obtained via the right femoral artery and right femoral vein via modified Seldinger technique, after 1% lidocaine was used to anethetize the area. A 6-French short sheath was placed in the right femoral artery. An 8-French sheath was placed in the right femoral vein. Both were flushed without any complications. We introduced a 7-French Swan-Ganz catheter through the 8-French venous access. The right heart catheterization was initially performed. We then paid attention to the coronary angiography. We initially used a JL-4 diagnosis catheter. We had to upgrade to a JL-5. This was used to selectively engage the left main artery. The left coronary system was studied. A JR4 catheter was then exchanged over the wire. This was used to selectively engage the right coronary artery. The right coronary system was studied. A pigtail cataract surgery was then exchanged over the wire. This was introduced into the left ventricle across the aortic valve. Hemodyamic measurements were taken. An LV gram was performed. The catheter was then withdrawn across the aortic valve to measure for any significant gradient. The cataract surgery was pulled back to the level of the renals. Abdominal flush was performed. Selective angiogram shot of the right femoral access site was then taken. A 6-French Mynx was deployed to obtain hemostasis. The patient tolerated the procedure well and there were no complications.

    Hemodynamics:
    1. Right atrial mean pressure was 4mmHg.
    2. RV was 40/0 mmHg.
    3. PA was 39/17 mmHg.
    4. Pulmonary capillary wedge pressure of 7 mmHg.

    Findings:
    1. Left main is normal
    2. LAD normal
    3. Left circumflex had mild nonobstructive plaque. This is the dominant vessel. There was also mid nonobstructive plaque in the the proximal portion of the PDA.
    4. RCA is nondominant. There is mild nonobstructive plaque.
    5. LVEF was 55% to 60%. There is evidence of LVH. EDP was 18 mmHg.

    Diagnoses:
    1. No significant coronary artery disease (there was no culprit lesion identified for a non-ST-elevation myocardial infarction?)
    2. Non-ST-elevation myocardial infarction?
    3. Flash pulmonary edema?
    4. Normal left ventricular systolic function.
    5. Patent Renals
    6. Diastolic dysfunction with increased end-diastolic pressure.


    Any help is greatly appreciated!

  2. #2
    Default
    Quote Originally Posted by AshleyMartin View Post
    My physician is coding a R&LHC and bilateral Renal angio for the following, Please advise what codes should be billed. I am not sure if the documentation supports the bilateral renal angio.

    Indication:
    The patient is a 64 year old female who experienced flash pulmonary edema? as well as a non-STEMI was a troponin of 1.

    Procedures:
    1. Left Heart Cath with selective coronary angiography
    2. Left ventriculogram
    3. Right heart cath
    4. Abdominal flush.

    The patient was prepped and draped in sterile fashion. Access was obtained via the right femoral artery and right femoral vein via modified Seldinger technique, after 1% lidocaine was used to anethetize the area. A 6-French short sheath was placed in the right femoral artery. An 8-French sheath was placed in the right femoral vein. Both were flushed without any complications. We introduced a 7-French Swan-Ganz catheter through the 8-French venous access. The right heart catheterization was initially performed. We then paid attention to the coronary angiography. We initially used a JL-4 diagnosis catheter. We had to upgrade to a JL-5. This was used to selectively engage the left main artery. The left coronary system was studied. A JR4 catheter was then exchanged over the wire. This was used to selectively engage the right coronary artery. The right coronary system was studied. A pigtail cataract surgery was then exchanged over the wire. This was introduced into the left ventricle across the aortic valve. Hemodyamic measurements were taken. An LV gram was performed. The catheter was then withdrawn across the aortic valve to measure for any significant gradient. The cataract surgery was pulled back to the level of the renals. Abdominal flush was performed. Selective angiogram shot of the right femoral access site was then taken. A 6-French Mynx was deployed to obtain hemostasis. The patient tolerated the procedure well and there were no complications.

    Hemodynamics:
    1. Right atrial mean pressure was 4mmHg.
    2. RV was 40/0 mmHg.
    3. PA was 39/17 mmHg.
    4. Pulmonary capillary wedge pressure of 7 mmHg.

    Findings:
    1. Left main is normal
    2. LAD normal
    3. Left circumflex had mild nonobstructive plaque. This is the dominant vessel. There was also mid nonobstructive plaque in the the proximal portion of the PDA.
    4. RCA is nondominant. There is mild nonobstructive plaque.
    5. LVEF was 55% to 60%. There is evidence of LVH. EDP was 18 mmHg.

    Diagnoses:
    1. No significant coronary artery disease (there was no culprit lesion identified for a non-ST-elevation myocardial infarction?)
    2. Non-ST-elevation myocardial infarction?
    3. Flash pulmonary edema?
    4. Normal left ventricular systolic function.
    5. Patent Renals
    6. Diastolic dysfunction with increased end-diastolic pressure.


    Any help is greatly appreciated!


    93460, G0275

    HTH,
    Jim Pawloski, CIRCC

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