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pericardiocentesis w/cors and stent

  1. #1
    Default pericardiocentesis w/cors and stent
    Medical Coding Books
    Operative report says that coronary angiography was done, a stent was placed in the LAD and an emergency pericardiocentesis was done with angiographic views of the pericardial sac. Finally, a Swan-Ganz was secured in place for hemodynamic monitorying as well as the pericardial catheter.

    The codes I am thinking are:

    92980 LD
    93454 -26-59

    Am I way off track here?

  2. #2
    It's not really that cut and dry with some of those codes. It would be ideal if you posted the entire op report, with any patient identifiers removed of course.

    From what you have mentioned there, I would point out a couple of areas which I would recommend investigating the documentation further:

    1. 76930 is for ultrasound, but you mention angiographic views of the pericardial sac, so this is somewhat confusing and worth verifying if they were actually ultrasound images being obtained.

    2. 93503 is usually used in a bedside Swan placement situation for hemodynamic monitoring. However from your brief statement, it seems this procedure was done along with the other procedures in the cath lab, so you would need to investigate if it was a full right heart cath with documented pressures and such, if so then the code may need to be changed to 93451 instead.

    3. Assuming your statement jives with the documentation, nice catch on using 33015 instead of 33010. 33010 indicates a simple tap of fluid, whereas the procedure indicated in 33015 involves the catheter being left in place as you said in your report. Sounds like a minor difference to many people, but I see a lot of coders get it wrong and it's a very costly mistake to make for both physician and facility, you can end up leaving a LOT of money on the table. 33010 is often done as a simple outpatient procedure and 33015 is almost universally an inpatient procedure.

    I don't have a problem with the other codes, but the op report would make me more comfortable sharing advice.

    Hope this helps.

    Rich Carrillo, CCS, CPC

  3. #3
    Thanks so much, Rick. I will list the the portion of the op report in question (after cors and stent done):

    The stent was advanced in the LAD with moderate difficulty. In the process, the wire in the diagonal branch caused large diagonal perforation. The patient becaome hemodynamically unstable and it became clinically evident that the patient is developing tamponade. Emergency echocardiogram confirmed the presence of large pericardial effusion. A 2.25 Maverick balloon was advanced into the diagonal branch in the mid segment. The balloon was inflated at 9 atmospheres to include the distal flow to the diagonal branch where the perforation was located. Pericardiocentesis catheter was introduced and secured in place. A total of 500 cc of sanguineous pericardial effusion was removed. The patient became hemodynamically stable. Subsequent angiographic views noted there is no active bleeding into the pericaridial sac. Final angiographic views demonstrated no residual stenosis with normal distal flow in the LAD. Finally, an 8-French venous sheath was introduced in the femoral vein and Swan-Ganz catheter was advanced into the pulmonary artery for hemodynamic monitoring. The femoral arterial sheath and Swan-Ganz catheter was secured in place. The pericardial catheter was also sutured in place. The patient was returned to the coronary care unit for further monitoring.

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