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Left Heart Cath - radial approach

  1. #1
    Question Left Heart Cath - radial approach
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    Our physician is billing a left heart cath (radial approach). Would this impact my coding of 93458? I know almost all caths are performed through the patients groin!

    SUMMARY:

    -- CORONARY CIRCULATION:
    -- There was 1-vessel coronary artery disease ( 75 % circumflex).

    -- CARDIAC STRUCTURES:
    -- Global left ventricular function was normal. EF calculated by contrast
    ventriculography was 60 %.

    PROCEDURES PERFORMED:

    -- Left heart catheterization with ventriculography.
    -- Right coronary angiography.
    -- Left coronary angiography.
    -- Hemostasis with TR Band.

    RECOMMENDATIONS:
    May need OM stent if CP recurrent.

    INDICATIONS: Angina/MI: unstable angina.

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

    VALVES: AORTIC VALVE: The aortic valve was evaluated by left
    ventriculography. The aortic valve appeared to be structurally normal. The
    aortic valve leaflets exhibited normal thickness and normal excursion.
    There was no aortic stenosis. MITRAL VALVE: The mitral valve was evaluated
    by left ventriculography. The mitral valve appeared grossly normal. The
    mitral leaflets exhibited normal thickness and normal excursion. The
    mitral valve exhibited no regurgitation.

    CORONARY VESSELS: The coronary circulation is right dominant. There was
    1-vessel coronary artery disease ( 75 % circumflex). Left main: Normal.
    LAD: Normal. Circumflex: Angiography showed minor luminal irregularities.
    1st obtuse marginal: There was a 75 % stenosis. There was TIMI grade 3
    flow through the vessel (brisk flow). RCA: Normal.

    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 radial 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 catheter 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.

    -- 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.

    -- 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.

    -- Hemostasis with TR Band..

    COMPLICATIONS:
    None occurred during the cath lab visit.
    PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
    Test started at 14:43. Test concluded at 15:34. RADIATION EXPOSURE:
    Fluoroscopy time: 1.4 min.
    MEDICATIONS GIVEN:
    Midazolam, 1 mg, IV, at 14:43.
    Midazolam, 1 mg, IV, at 14:47.
    Verapamil (Isoptin, Calan, Covera), 1.25 mcg, intracoronary, at 14:48.
    Nitroglycerin, 400 mcg, intracoronary, at 14:48.
    Heparin, 3000 units, IA, last dose at 14:49.
    1% Lidocaine, 6 ml, subcutaneously, at 14:43.
    CONTRAST GIVEN:
    Omnipaque 125 ml.

    STUDY DIAGRAM

    Angiographic findings
    Native coronary lesions:
    7OM1: Lesion 1: 75 % stenosis.

    HEMODYNAMIC TABLES

    Pressures: NO PHASE
    Pressures: - HR: 79
    Pressures: - Rhythm:
    Pressures: -- Aortic Pressure (S/D/M): 119/78/98
    Pressures: -- Left Ventricle (s/edp): 123/9/--

    Outputs: NO PHASE
    Outputs: -- CALCULATIONS: Age in years: 54.79
    Outputs: -- CALCULATIONS: Body Surface Area: 2.64
    Outputs: -- CALCULATIONS: Height in cm: 183.00
    Outputs: -- CALCULATIONS: Sex: Male
    Outputs: -- CALCULATIONS: Weight in kg: 149.70

  2. #2
    Default
    The radial access vs. femoral access would not change the code 93458. Thanks!

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