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93458 + Aortogram

  1. #1
    Question 93458 + Aortogram
    Exam Training Packages
    Can I bill for the Aortogram? Why or why not?

    SUMMARY:

    -- CORONARY CIRCULATION:
    -- Coronary angiography demonstrated minor luminal irregularities.

    -- CARDIAC STRUCTURES:
    -- Global left ventricular function was normal. EF calculated by contrast
    ventriculography was 55 %.

    -- SPLANCHNIC AND RENAL VESSELS:
    -- The renal arteries were widely patent and grossly angiographically
    normal. Two left renal arteries were identified, a single right renal
    artery was also idenitified.

    PROCEDURES PERFORMED:

    -- Left heart catheterization with ventriculography.
    -- Left coronary angiography.
    -- Right coronary angiography.
    -- Aortography.

    RECOMMENDATIONS:
    The patient should continue with the present medications.

    INDICATIONS: Angina/MI: atypical chest pain. Coronary artery disease:
    abnormal stress test. Renal: malignant HTN.

    VENTRICLES: There were no left ventricular global or regional wall motion
    abnormalities. Global left ventricular function was normal. EF calculated
    by contrast ventriculography was 55 %.

    CORONARY VESSELS: Coronary angiography demonstrated minor luminal
    irregularities. Left main: Normal. The vessel was medium sized but short.
    LAD: Angiography showed mild atherosclerosis. Circumflex: The vessel was
    large sized (dominant). Angiography showed mild atherosclerosis. Distal
    circumflex: Angiography showed moderate atherosclerosis. RCA: The vessel
    was small sized. Angiography showed moderate atherosclerosis.

    ABDOMINAL VESSELS: The renal arteries were widely patent and grossly
    angiographically normal. Two left renal arteries were identified, a single
    right renal artery was also idenitified.

    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.

    -- Aortography. A catheter was placed and contrast was injected.

    COMPLICATIONS:
    There were no adverse outcomes.
    PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
    Test started at 15:45. Test concluded at 15:58. RADIATION EXPOSURE:
    Fluoroscopy time: 1.9 min.
    HEMOSTASIS:
    The sheath was removed. The site was compressed manually. Hemostasis was
    successful.
    MEDICATIONS GIVEN:
    Midazolam, 1 mg, IV, at 15:41.
    Fentanyl, 25 mcg, IV, at 15:41.
    Midazolam, 1 mg, IV, at 15:42.
    1% Lidocaine, 20 ml, subcutaneously, at 15:45.
    CONTRAST GIVEN:
    Omnipaque 60 ml.

    STUDY DIAGRAM

    HEMODYNAMIC TABLES

    Pressures: NO PHASE
    Pressures: - HR: 73
    Pressures: - Rhythm:
    Pressures: -- Aortic Pressure (S/D/M): 140/76/100
    Pressures: -- Left Ventricle (s/edp): 137/8/--

    Outputs: NO PHASE
    Outputs: -- CALCULATIONS: Age in years: 56.86
    Outputs: -- CALCULATIONS: Body Surface Area: 2.44
    Outputs: -- CALCULATIONS: Height in cm: 183.00
    Outputs: -- CALCULATIONS: Sex: Male
    Outputs: -- CALCULATIONS: Weight in kg: 124.70

  2. #2
    Default
    Quote Originally Posted by amym View Post
    Can I bill for the Aortogram? Why or why not?

    SUMMARY:

    -- CORONARY CIRCULATION:
    -- Coronary angiography demonstrated minor luminal irregularities.

    -- CARDIAC STRUCTURES:
    -- Global left ventricular function was normal. EF calculated by contrast
    ventriculography was 55 %.

    -- SPLANCHNIC AND RENAL VESSELS:
    -- The renal arteries were widely patent and grossly angiographically
    normal. Two left renal arteries were identified, a single right renal
    artery was also idenitified.

    PROCEDURES PERFORMED:

    -- Left heart catheterization with ventriculography.
    -- Left coronary angiography.
    -- Right coronary angiography.
    -- Aortography.

    RECOMMENDATIONS:
    The patient should continue with the present medications.

    INDICATIONS: Angina/MI: atypical chest pain. Coronary artery disease:
    abnormal stress test. Renal: malignant HTN.

    VENTRICLES: There were no left ventricular global or regional wall motion
    abnormalities. Global left ventricular function was normal. EF calculated
    by contrast ventriculography was 55 %.

    CORONARY VESSELS: Coronary angiography demonstrated minor luminal
    irregularities. Left main: Normal. The vessel was medium sized but short.
    LAD: Angiography showed mild atherosclerosis. Circumflex: The vessel was
    large sized (dominant). Angiography showed mild atherosclerosis. Distal
    circumflex: Angiography showed moderate atherosclerosis. RCA: The vessel
    was small sized. Angiography showed moderate atherosclerosis.

    ABDOMINAL VESSELS: The renal arteries were widely patent and grossly
    angiographically normal. Two left renal arteries were identified, a single
    right renal artery was also idenitified.

    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.

    -- Aortography. A catheter was placed and contrast was injected.

    COMPLICATIONS:
    There were no adverse outcomes.
    PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
    Test started at 15:45. Test concluded at 15:58. RADIATION EXPOSURE:
    Fluoroscopy time: 1.9 min.
    HEMOSTASIS:
    The sheath was removed. The site was compressed manually. Hemostasis was
    successful.
    MEDICATIONS GIVEN:
    Midazolam, 1 mg, IV, at 15:41.
    Fentanyl, 25 mcg, IV, at 15:41.
    Midazolam, 1 mg, IV, at 15:42.
    1% Lidocaine, 20 ml, subcutaneously, at 15:45.
    CONTRAST GIVEN:
    Omnipaque 60 ml.

    STUDY DIAGRAM

    HEMODYNAMIC TABLES

    Pressures: NO PHASE
    Pressures: - HR: 73
    Pressures: - Rhythm:
    Pressures: -- Aortic Pressure (S/D/M): 140/76/100
    Pressures: -- Left Ventricle (s/edp): 137/8/--

    Outputs: NO PHASE
    Outputs: -- CALCULATIONS: Age in years: 56.86
    Outputs: -- CALCULATIONS: Body Surface Area: 2.44
    Outputs: -- CALCULATIONS: Height in cm: 183.00
    Outputs: -- CALCULATIONS: Sex: Male
    Outputs: -- CALCULATIONS: Weight in kg: 124.70
    Yes you can! If the patient has Medicare, code G0275, non Medicare 75625.
    HTH,
    Jim Pawloski, CIRCC

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