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Need assistance on a CPT case study

  1. Default Need assistance on a CPT case study
    Medical Coding Books
    I am currently a student for Medical billing and Coding. I have recently come across a case study that I seem to be getting no where on. I can find codes from 2010 that would work , but have been deleted and it looks like you can't combine any codes in cardio that seem to fit for injections. Any help would be greatly appreciated.
    Left heart catheterization with coronary angiography and left ventriculogram:
    The right groin was prepped and draped in the usual fashion. Seldinger techinique was used and a 6-french sheath was placed in the right femoral artery. A local anesthetic was used and sublingual nitroglycerin was given, no heparin was used. The left and right coronary arteries were selectively opacified in the LAO and RAO projections using manual injections of Optiray.
    A ventriculogram was done in the RAO projection with the use of a 6-French pigtail catheter. The catheters were then withdrawn, the sheath was removed and VasoSeal applied, and the patient was sent to her room in good condition without complication. Pressures: Aorta 117/63,LV 110/2-6 Right Coronary Artery:This is a dominant vessel. There is a long segment of severe subtotal disease extending from the proximal portion to almost the mid third. The rest of this vessel also appears to be diffusely diseased. The posterior descending branch is identified and this 80% narrowed at its ostium. There is another 90% lesion in the distal 1/3 of this vessel. The AV branch is diminutive.
    Left Coronary Artery: Left main trunk is calcified and has a 60%-70% distal narrowing. Left anterior descending is severely diseased from it's origin, and gives off a diagonal and septal perforator and then the LAD is totally occluded. The circumflex calcification is seen in the main trunk where moderate plaque is seen compromising the lumen about 50%-60%. The circumflex then divides into two branches; the first is the lateral branch and then a second lateral branch. The first lateral branch is severaly narrowed in tis proximal portion to 90% and then has antoher long segment of about 75% narrowing. This does appear to be a diffusely diseased vessel. The second lateral branch also has a long segment of 90% disease distally. The terminal AV branch of the circumflex is completely occluded. Procedure performed:Cardioversion.

  2. #2
    Well, The cardiac cath code would be the 93458 (left heart cath w/wo LV coronary angiography.

    I am not sure where the cardioversion came from, as other than the last sentence of the note, there is no mention of it, but if it is to be coded, it would be 92960.

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