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Right/left Heart cath w/root

  1. #1
    Default Right/left Heart cath w/root
    Medical Coding Books
    I am making sure i haven't missed anything in the following cath report.. i have 93460-26 and 93567. Are there any other add on codes for the pressures, cardiac output and thermodilution that i'm missing or are they included in the cath codes already?
    Thanks.. i don't get the R/L Caths a lot so i just wanted to double check!!


    PROCEDURE: Left and right heart catheterization with selective
    coronary arteriography, left ventriculography, distal aortic root
    shot.

    A. DYE USED: Less than 100 cc's of dye.
    B. COMPLICATIONS: No acute or apparent complications.
    C. PREMEDICATIONS: 25mg of p.o. Benadryl and 5mg of p.o.
    Valium.
    D. TECHNIQUE: Modified Seldinger technique through the right
    femoral artery and right femoral vein.
    E. CATHETERS: 5 French sheath in right femoral artery, 7
    French sheath in the right femoral vein with 7 French Swan-
    Ganz catheter. JL4 and JR4 were noted and 5 French pigtail
    were used.

    PRESSURES/SATURATIONS: IVC saturation was 78. SVG 65, PA 70, high
    RA 71.8, RV 69.5. AO 99%. No apparent shunting was identified on
    the right side.

    Cardiac output and index using thermodilution were 4.5 and 2.6.

    Pressures were noted. Aortic pressure was 130/80. LV was
    129/17. EDP was normal. No apparent aortic valve gradient was
    noted. RA mean pressure was 4. RV was 20/4. PA pressure was
    about 20/10. Right sided pressures were relatively within normal
    limits.

    ANGIOGRAMS:

    A. LEFT MAIN: Left main coronary artery had a normal
    arteriogram.

    B. LEFT ANTERIOR DESCENDING: The LAD had a 20-30%
    irregularities throughout its course. Some calicification.
    First diagonal was a moderate calibered vessel and had a normal arteriogram.
    C. CIRCUMFLEX: The circumflex artery was a moderate calibered
    vessel artery. It gave rise to an OM1, which was moderate
    and had 20-30% irregularities. OM2 was moderate and had 20-
    30% irregularities.
    D. RAMUS INTERMEDIUS BRANCH: Ramus intermedius branch was a
    moderate calibered vessel artery. It had 20-30%
    irregularities.
    E. RIGHT CORONARY ARTERY: RCA was dominant. It had 20%
    irregularities. PDA was a moderate calibered vessel artery
    and had a normal arteriogram. PL branch was a moderate
    calibered vessel artery and had a normal arteriogram.

    LEFT VENTRICULAR: LV was visualized in RAO projection. EF was
    estimated at 60%. Plus 1 MR was noted. Volumes were within
    normal limits.

    DISTAL AORTIC ROOT SHOT: Distal aortic root looked at the renal
    arteries non-selectively, which did not have any significant
    disease. 20-30% irregularities were noted in the left renal
    artery.

    IMPRESSION:
    1. Right-sided pressures were normal. No apparent shunting
    was noted on the right side. Cardiac output index was
    normal. LVEF was normal. Plus 1 MR is noted. Coronaries
    had 20-30% irregularities in the left system and right
    system.
    2. Renals did not have any significant disease

  2. #2
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by sslater View Post
    I am making sure i haven't missed anything in the following cath report.. i have 93460-26 and 93567. Are there any other add on codes for the pressures, cardiac output and thermodilution that i'm missing or are they included in the cath codes already?
    Thanks.. i don't get the R/L Caths a lot so i just wanted to double check!!


    PROCEDURE: Left and right heart catheterization with selective
    coronary arteriography, left ventriculography, distal aortic root
    shot.

    A. DYE USED: Less than 100 cc's of dye.
    B. COMPLICATIONS: No acute or apparent complications.
    C. PREMEDICATIONS: 25mg of p.o. Benadryl and 5mg of p.o.
    Valium.
    D. TECHNIQUE: Modified Seldinger technique through the right
    femoral artery and right femoral vein.
    E. CATHETERS: 5 French sheath in right femoral artery, 7
    French sheath in the right femoral vein with 7 French Swan-
    Ganz catheter. JL4 and JR4 were noted and 5 French pigtail
    were used.

    PRESSURES/SATURATIONS: IVC saturation was 78. SVG 65, PA 70, high
    RA 71.8, RV 69.5. AO 99%. No apparent shunting was identified on
    the right side.

    Cardiac output and index using thermodilution were 4.5 and 2.6.

    Pressures were noted. Aortic pressure was 130/80. LV was
    129/17. EDP was normal. No apparent aortic valve gradient was
    noted. RA mean pressure was 4. RV was 20/4. PA pressure was
    about 20/10. Right sided pressures were relatively within normal
    limits.

    ANGIOGRAMS:

    A. LEFT MAIN: Left main coronary artery had a normal
    arteriogram.

    B. LEFT ANTERIOR DESCENDING: The LAD had a 20-30%
    irregularities throughout its course. Some calicification.
    First diagonal was a moderate calibered vessel and had a normal arteriogram.
    C. CIRCUMFLEX: The circumflex artery was a moderate calibered
    vessel artery. It gave rise to an OM1, which was moderate
    and had 20-30% irregularities. OM2 was moderate and had 20-
    30% irregularities.
    D. RAMUS INTERMEDIUS BRANCH: Ramus intermedius branch was a
    moderate calibered vessel artery. It had 20-30%
    irregularities.
    E. RIGHT CORONARY ARTERY: RCA was dominant. It had 20%
    irregularities. PDA was a moderate calibered vessel artery
    and had a normal arteriogram. PL branch was a moderate
    calibered vessel artery and had a normal arteriogram.

    LEFT VENTRICULAR: LV was visualized in RAO projection. EF was
    estimated at 60%. Plus 1 MR was noted. Volumes were within
    normal limits.

    DISTAL AORTIC ROOT SHOT: Distal aortic root looked at the renal
    arteries non-selectively, which did not have any significant
    disease. 20-30% irregularities were noted in the left renal
    artery.

    IMPRESSION:
    1. Right-sided pressures were normal. No apparent shunting
    was noted on the right side. Cardiac output index was
    normal. LVEF was normal. Plus 1 MR is noted. Coronaries
    had 20-30% irregularities in the left system and right
    system.
    2. Renals did not have any significant disease


    Pressures and output are included in the heart cath code (93460), however, 93567 does not apply in this case. The aortic "root" is the portion of the aorta that connects to the heart, not the distal area above the bifurcation. For non-selected renals you should code G0275 or 75625 depending on payor.

    For future reference, 93567 supravalvular aortography, is an add on code for evaluation of the area of the aorta extending (ascending) from the heart to the arch.

    HTH
    Danny L. Peoples
    CIRCC,CPC

  3. #3
    Question CIRC cert
    Hi Danny,

    I noticed in a previous post a poster had asked you about the CIRC certification and how much time you spent studying etc. I am an inpatient physician coder and have been coding for about 2 years now. I am starting to see more and more cardiac/circ charts as my company assigns me to different facilities. If it's not too much trouble, could you tell me how you went about preparing for the exam and how intense the exam is. Is there one prep course you recommend? My personal email is bailsb@hotmail.com.

    I really appreciate your help,
    Brendan, CPC

  4. #4
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by bailsb View Post
    Hi Danny,

    I noticed in a previous post a poster had asked you about the CIRC certification and how much time you spent studying etc. I am an inpatient physician coder and have been coding for about 2 years now. I am starting to see more and more cardiac/circ charts as my company assigns me to different facilities. If it's not too much trouble, could you tell me how you went about preparing for the exam and how intense the exam is. Is there one prep course you recommend? My personal email is bailsb@hotmail.com.

    I really appreciate your help,
    Brendan, CPC
    Brendan, check your private messages on this forum, let me know if that doesn't work.
    dp
    Danny L. Peoples
    CIRCC,CPC

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