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93459 + Bypass Angio?

  1. #1
    Question 93459 + Bypass Angio?
    Medical Coding Books
    Physician turned in charges for LHC + Grafts and Bypass Angio. I have attached a report and am not sure how to code the Bypass Angio. Please help!

    SUMMARY:

    -- CARDIAC STRUCTURES:
    -- Global left ventricular function was normal. EF estimated was 60 %.

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

    PROCEDURES PERFORMED:

    -- Left heart catheterization with ventriculography.
    -- Left coronary angiography.
    -- Right coronary angiography.
    -- Saphenous vein graft angiography.
    -- LIMA graft angiography.

    RECOMMENDATIONS:
    EF60%, no MR, R dominant. LM has LI. LCX has LI. Small ramus has ostial
    70%. LAD has LI. RCA has distal 50% stenosis before the crux. VG to distal
    RCA is widely patent. LIMA to LAD is atretic and subtotalled. Medical
    therapy and risk factor modification.

    INDICATIONS: chest pain and abnormal stress test

    HEMODYNAMICS: Hemodynamic assessment demonstrates moderate systemic
    hypertension.

    VENTRICLES: There were no left ventricular global or regional wall motion
    abnormalities. Global left ventricular function was normal. EF estimated
    was 60 %.

    VALVES: MITRAL VALVE: The mitral valve exhibited no regurgitation.

    CORONARY VESSELS: The coronary circulation is right dominant. non
    obstructive coronary artery disease, atretic LIMA. Left main: Angiography
    showed minor luminal irregularities. LAD: Angiography showed mild
    atherosclerosis. Circumflex: Angiography showed mild atherosclerosis.
    Ramus intermedius: The vessel was very small sized. There was a 70 %
    stenosis at the ostium of the vessel segment. RCA: Angiography showed mild
    atherosclerosis. There was a 50 % stenosis in the distal third of the
    vessel segment. Graft to the LAD: The graft was a LIMA. There was a 99 %
    stenosis at the distal anastomosis.

    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.

    -- 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. Ventriculography was performed using power injection of contrast
    agent. 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.

    -- Saphenous vein graft angiography. A catheter was advanced to the aorta
    and positioned at the aortic anastomosis of the graft under fluoroscopic
    guidance. Angiography was performed in multiple projections using
    hand-injection of contrast.

    -- Left internal mammary graft angiography. A catheter was advanced to
    the aorta and positioned at the aortic anastomosis of the graft under
    fluoroscopic guidance. Angiography was performed in multiple projections
    using hand-injection of contrast.

    COMPLICATIONS:
    None occurred during the cath lab visit.
    PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
    Test started at 09:30. Test concluded at 10:17. RADIATION EXPOSURE:
    Fluoroscopy time: 20.7 min.
    MEDICATIONS GIVEN:
    Midazolam, 1 mg, IV, at 09:30.
    CONTRAST GIVEN:
    Omnipaque 160 ml.

    STUDY DIAGRAM

    Angiographic findings
    Native coronary lesions:
    7Ramus intermedius: Lesion 1: 70 % stenosis.
    7RCA: Lesion 1: 50 % stenosis.

    Coronary graft lesions:
    7Graft to LAD: LIMA 7 99 % stenosis at distal anastomosis.

    HEMODYNAMIC TABLES

    Pressures: NO PHASE
    Pressures: - HR: 53
    Pressures: - Rhythm:
    Pressures: -- Aortic Pressure (S/D/M): 202/61/112

    Outputs: NO PHASE
    Outputs: -- CALCULATIONS: Age in years: 85.37
    Outputs: -- CALCULATIONS: Body Surface Area: 1.60
    Outputs: -- CALCULATIONS: Height in cm: 157.00
    Outputs: -- CALCULATIONS: Sex: Female
    Outputs: -- CALCULATIONS: Weight in kg: 60.10

  2. #2
    Default
    Quote Originally Posted by amym View Post
    Physician turned in charges for LHC + Grafts and Bypass Angio. I have attached a report and am not sure how to code the Bypass Angio. Please help!

    SUMMARY:

    -- CARDIAC STRUCTURES:
    -- Global left ventricular function was normal. EF estimated was 60 %.

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

    PROCEDURES PERFORMED:

    -- Left heart catheterization with ventriculography.
    -- Left coronary angiography.
    -- Right coronary angiography.
    -- Saphenous vein graft angiography.
    -- LIMA graft angiography.

    RECOMMENDATIONS:
    EF60%, no MR, R dominant. LM has LI. LCX has LI. Small ramus has ostial
    70%. LAD has LI. RCA has distal 50% stenosis before the crux. VG to distal
    RCA is widely patent. LIMA to LAD is atretic and subtotalled. Medical
    therapy and risk factor modification.

    INDICATIONS: chest pain and abnormal stress test

    HEMODYNAMICS: Hemodynamic assessment demonstrates moderate systemic
    hypertension.

    VENTRICLES: There were no left ventricular global or regional wall motion
    abnormalities. Global left ventricular function was normal. EF estimated
    was 60 %.

    VALVES: MITRAL VALVE: The mitral valve exhibited no regurgitation.

    CORONARY VESSELS: The coronary circulation is right dominant. non
    obstructive coronary artery disease, atretic LIMA. Left main: Angiography
    showed minor luminal irregularities. LAD: Angiography showed mild
    atherosclerosis. Circumflex: Angiography showed mild atherosclerosis.
    Ramus intermedius: The vessel was very small sized. There was a 70 %
    stenosis at the ostium of the vessel segment. RCA: Angiography showed mild
    atherosclerosis. There was a 50 % stenosis in the distal third of the
    vessel segment. Graft to the LAD: The graft was a LIMA. There was a 99 %
    stenosis at the distal anastomosis.

    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.

    -- 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. Ventriculography was performed using power injection of contrast
    agent. 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.

    -- Saphenous vein graft angiography. A catheter was advanced to the aorta
    and positioned at the aortic anastomosis of the graft under fluoroscopic
    guidance. Angiography was performed in multiple projections using
    hand-injection of contrast.

    -- Left internal mammary graft angiography. A catheter was advanced to
    the aorta and positioned at the aortic anastomosis of the graft under
    fluoroscopic guidance. Angiography was performed in multiple projections
    using hand-injection of contrast.

    COMPLICATIONS:
    None occurred during the cath lab visit.
    PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
    Test started at 09:30. Test concluded at 10:17. RADIATION EXPOSURE:
    Fluoroscopy time: 20.7 min.
    MEDICATIONS GIVEN:
    Midazolam, 1 mg, IV, at 09:30.
    CONTRAST GIVEN:
    Omnipaque 160 ml.

    STUDY DIAGRAM

    Angiographic findings
    Native coronary lesions:
    7Ramus intermedius: Lesion 1: 70 % stenosis.
    7RCA: Lesion 1: 50 % stenosis.

    Coronary graft lesions:
    7Graft to LAD: LIMA 7 99 % stenosis at distal anastomosis.

    HEMODYNAMIC TABLES

    Pressures: NO PHASE
    Pressures: - HR: 53
    Pressures: - Rhythm:
    Pressures: -- Aortic Pressure (S/D/M): 202/61/112

    Outputs: NO PHASE
    Outputs: -- CALCULATIONS: Age in years: 85.37
    Outputs: -- CALCULATIONS: Body Surface Area: 1.60
    Outputs: -- CALCULATIONS: Height in cm: 157.00
    Outputs: -- CALCULATIONS: Sex: Female
    Outputs: -- CALCULATIONS: Weight in kg: 60.10
    The 93459 is correct. That would be the only code. The grafts/IMA is included in this code.

    Jessica CPC, CCC

  3. Default
    93459 is apropriate code...

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