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Thread: LT+RT Heart Cath +

  1. #1

    Question LT+RT Heart Cath +

    Is it appropriate to bill 93460-26 and 93567 for the following case?

    SUMMARY:

    -- CORONARY CIRCULATION:
    -- There was 1-vessel coronary artery disease ( 30 % LAD).

    -- HEMODYNAMICS:
    -- Hemodynamic assessment demonstrates mild systemic hypertension.

    PROCEDURES PERFORMED:

    -- Right heart catheterization.
    -- Left heart catheterization.
    -- Left coronary angiography.
    -- Right coronary angiography.
    -- Ascending aortography.

    RECOMMENDATIONS:
    The patient should continue with the present medications.

    INDICATIONS: Cardiac: aortic valve disease.

    HEMODYNAMICS: Not done as Aortic valve was not crossed Hemodynamic
    assessment demonstrates mild systemic hypertension.

    VENTRICLES: Aortic valve could not be crossed due to severe stenosis and
    angulation.

    CORONARY VESSELS: The coronary circulation is right dominant. There was
    1-vessel coronary artery disease ( 30 % LAD). There was no angiographic
    evidence for occlusive coronary artery disease. Left main: Normal. Mid
    LAD: There was a 30 % stenosis. Circumflex: Normal. RCA: Angiography
    showed minor luminal irregularities.

    PROCEDURE: The risks and alternatives of the procedures and conscious
    sedation were explained to the patient and informed consent was obtained.
    The patient was brought to the cath lab and placed on the table. The
    planned puncture sites were prepped and draped in the usual sterile
    fashion.

    -- Right femoral artery access. The puncture site was infiltrated with
    local anesthetic. The vessel was accessed using the modified Seldinger
    technique, a wire was threaded into the vessel, and a sheath was advanced
    over the wire into the vessel.

    -- Right femoral vein access. The puncture site was infiltrated with
    local anesthetic. The vessel was accessed using the modified Seldinger
    technique, a wire was threaded into the vessel, and a sheath was advanced
    over the wire into the vessel.

    -- Right heart catheterization. A catheter was advanced to the pulmonary
    artery wedge position under fluoroscopic guidance. Measurements of
    pressures and arterial and venous oxygen saturation were obtained. The
    catheter remained in place throughout the procedure for continuous
    monitoring of pulmonary artery pressure.

    -- Left heart catheterization. A catheter was advanced to the ascending
    aorta. After recording ascending aortic pressure, the catheter was
    advanced across the aortic valve and left ventricular pressure was
    recorded. Imaging was performed using an RAO projection.

    -- Left coronary artery angiography. A catheter was advanced to the aorta
    and positioned in the vessel ostium under fluoroscopic guidance.
    Angiography was performed in multiple projections using hand-injection of
    contrast.

    -- Right coronary artery angiography. A catheter was advanced to the
    aorta and positioned in the vessel ostium under fluoroscopic guidance.
    Angiography was performed in multiple projections using hand-injection of
    contrast.

    -- Ascending aortography. A catheter was placed and contrast was
    injected.

  2. #2

    Default 93460-26 93567

    I would agree with these codes. The 2011 Coders Desk Reference for Procedures states 93567 is specific to the visualization of the valves above the aorta and it's branches.

    The dictations represents this by the following:

    HEMODYNAMICS: Not done as Aortic valve was not crossed Hemodynamic
    assessment demonstrates mild systemic hypertension.

    VENTRICLES: Aortic valve could not be crossed due to severe stenosis and
    angulation.

  3. #3
    Join Date
    Apr 2007
    Location
    Birmingham, Alabama
    Posts
    886

    Default

    Quote Originally Posted by amym View Post
    Is it appropriate to bill 93460-26 and 93567 for the following case?

    SUMMARY:

    -- CORONARY CIRCULATION:
    -- There was 1-vessel coronary artery disease ( 30 % LAD).

    -- HEMODYNAMICS:
    -- Hemodynamic assessment demonstrates mild systemic hypertension.

    PROCEDURES PERFORMED:

    -- Right heart catheterization.
    -- Left heart catheterization.
    -- Left coronary angiography.
    -- Right coronary angiography.
    -- Ascending aortography.

    RECOMMENDATIONS:
    The patient should continue with the present medications.

    INDICATIONS: Cardiac: aortic valve disease.

    HEMODYNAMICS: Not done as Aortic valve was not crossed Hemodynamic
    assessment demonstrates mild systemic hypertension.

    VENTRICLES: Aortic valve could not be crossed due to severe stenosis and
    angulation.


    CORONARY VESSELS: The coronary circulation is right dominant. There was
    1-vessel coronary artery disease ( 30 % LAD). There was no angiographic
    evidence for occlusive coronary artery disease. Left main: Normal. Mid
    LAD: There was a 30 % stenosis. Circumflex: Normal. RCA: Angiography
    showed minor luminal irregularities.


    PROCEDURE: The risks and alternatives of the procedures and conscious
    sedation were explained to the patient and informed consent was obtained.
    The patient was brought to the cath lab and placed on the table. The
    planned puncture sites were prepped and draped in the usual sterile
    fashion.

    -- Right femoral artery access. The puncture site was infiltrated with
    local anesthetic. The vessel was accessed using the modified Seldinger
    technique, a wire was threaded into the vessel, and a sheath was advanced
    over the wire into the vessel.

    -- Right femoral vein access. The puncture site was infiltrated with
    local anesthetic. The vessel was accessed using the modified Seldinger
    technique, a wire was threaded into the vessel, and a sheath was advanced
    over the wire into the vessel.

    -- Right heart catheterization. A catheter was advanced to the pulmonary
    artery wedge position under fluoroscopic guidance. Measurements of
    pressures and arterial and venous oxygen saturation were obtained. The
    catheter remained in place throughout the procedure for continuous
    monitoring of pulmonary artery pressure.

    -- Left heart catheterization. A catheter was advanced to the ascending
    aorta. After recording ascending aortic pressure, the catheter was
    advanced across the aortic valve and left ventricular pressure was
    recorded. Imaging was performed using an RAO projection.
    -

    - Left coronary artery angiography. A catheter was advanced to the aorta
    and positioned in the vessel ostium under fluoroscopic guidance.
    Angiography was performed in multiple projections using hand-injection of
    contrast.

    -- Right coronary artery angiography. A catheter was advanced to the
    aorta and positioned in the vessel ostium under fluoroscopic guidance.
    Angiography was performed in multiple projections using hand-injection of
    contrast.

    -- Ascending aortography. A catheter was placed and contrast was
    injected.


    I see an interpretation of the coronary vessels (in bold) but not of the valves/ascending aorta. I also see contradicition concerning the left heart cath, under procedures it says the aortic valve was crossed and left ventricular pressures obtained, but at the beginning of the report is says the opposite. hmm? I think perhaps this was a canned procedural report and l would code on the side of caution. I have:
    93456 Rt Heart cath and coronaries.


    HTH
    Danny L. Peoples
    CIRCC,CPC

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