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Am I coding this correctly? - had this procedure:

  1. Default Am I coding this correctly? - had this procedure:
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    Please help me code this:

    A 75 year old Female went to the cath lab and had this procedure:

    1. Coronary angiography
    2. LIMA angiography
    3. Saphenous vein graft angiography
    4. Temporary venous pacer
    5. Aspiration thrombectomy
    6. PCI of left circumflex with bare metal stent

    I will not post to op note because I have that one coded correctly. But this next one I have questions on.

    While being observed in the ICU, she continued to develop tachycardia as well as hypotension requiring significant pressors. She was brought back for re-look angiography plus/minus PCI of the LIMA as well as to verify no active bleeding at the prior arterial access site in the groin.

    1. Triple lumen catheter placement
    2. Intra-aortic balloon pump placement
    3. Abdominal aortogram
    4. PTA of the right common iliac artery.

    Procedure in detail:
    The patient was emergently brought back into the cath lab. She was prepped and drained in a sterile fashion. We exchanged a 6-French sheath in the right arterial access site for a 2-sheath under sterile technique. Angiography was performed at the right arterial access site showing no active extravasation of blood. The patient upon transfer to the table had also developed a bowel movement that was significantly bloody consistent with lower GI bleed. We then called GI emergently. Dr L came and placed an NG tube which aspirated no significant amount of blood. The patient was started on Protonix. We then exchanged the right venous access for a triple lumen and exchanged the 6-French arterial sheath for balloon pump sheath and placed a balloon pump after angiography was perfomed showing patency of the left main and the left circumflex. The balloon pump had some difficulty going up the iliac. There was a lesion of the right common iliac artery that was verified by abdominal aortogram. We then used a glide wire to pass it. A stiff Amplatz wire was exchanged over this 10x20 ultrathin SDS balloon was used to dilate the lesion. Then we were able to pass a balloon pump in the triple lumen as well as the balloon were sutured to the skin. Again, the patient was stable on pressors upon transfer the the ICU.

    1. The is eccentric calcified plaque at the ostium of the right common iliac artery.

    1. 80% lesion was reduced to less than 20% by PTA with a 10x20 millimeter ultra-thin SDS balloon.

    1. Lower GI bleed
    2. Patent stent in the left circumflex
    3. Acute systolic heart failure status post intra-aortic balloon pump placement.

    This is what I have:

    Do I append modifier 78 to all codes?

  2. #2
    Richardson, TX
    The new revascularization codes for LOWER EXTREMITYs include cath placements, S&I (except if it meets requirements to bill; add 59), transversing the lesion, closure of ateriotomy ect. See pg. 208 in CPT.

    That being said, I would bill 37220. 33967 - that's it. Not sure you need the 78 because the heart cath, thrombectomy or temp pm do not have globals. Should be different dx too. Maybe 440.20, if documented.
    Julie Graham, BA, CPC, CCC

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