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LHC, SVG and PCI stent to LC

  1. #1
    Default LHC, SVG and PCI stent to LC
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    Our doc has performed a Left Heart Cath, Saphenous Vein Graft angio and stent to the Left Circumflex. My question is, which codes should I use for the heart cath and svg? He never says he selects the coronary vessels so how do I break down the cath codes to show he did a LHC and SVG? Is it okay just to go ahead and use the 93458 even though he didn't select the cornary arteries? Or does he only get the 93452?

    Thanks for your help,

    Kim, CPC

  2. Default
    Quote Originally Posted by KimberlyAFloyd View Post
    Our doc has performed a Left Heart Cath, Saphenous Vein Graft angio and stent to the Left Circumflex. My question is, which codes should I use for the heart cath and svg? He never says he selects the coronary vessels so how do I break down the cath codes to show he did a LHC and SVG? Is it okay just to go ahead and use the 93458 even though he didn't select the cornary arteries? Or does he only get the 93452?

    Thanks for your help,

    Kim, CPC
    Kim,
    You would have to summit this report for anyone to give an answer. Minus the patient info and then we can look at it and explain why or why not.
    Theresa CCS-P CPMA CCC ICDCT-CM

  3. #3
    Default
    No problem. I'm really thrown off on the SVG. Thanks for responding.

    PROCEDURE
    1. Left heart catheterization.
    2. Saphenous vein graft injection.
    3. Percutaneous coronary intervention with drug-eluting stent to
    distal circumflex.

    INDICATION Unstable angina, borderline troponin.

    PROCEDURE IN DETAIL Risks, benefits, alternatives, goals, possible
    complications, need for team approach were discussed with the
    patient. Informed consent was obtained. A 5-French sheath was
    inserted into right femoral artery under sterile technique. We used
    JL4 Williams right, RCB pigtail to do left heart cath. This showed
    LVEDP 13. No gradient across the aortic valve. Ejection fraction
    50% with inferior wall hypokinesis. Right coronary artery was
    dominant, was 100% occluded proximally. There was a patent saphenous
    vein graft to right PDA that filled antegradely and retrogradely.
    The left main had diffuse 30%, LAD had diffuse 30% disease. The
    proximal circumflex had multiple 20% to 30% lesion. Distal
    circumflex had an 80% focal lesion. In view of the current
    presentation and recurrent hospitalization with the patient, decided
    to go ahead and treat that. Upsized to 6-French sheath, used XB 3.5
    to engage left main, provided good fit and support with a BMW wire
    crossed distally. I advanced a 2.25 x 8 Xience, deployed that at 12
    atmospheres, reduced the lesion in the distal circumflex from 80% to
    0% and TIMI-3 flow was maintained. At the end of procedure, the
    patient was hemodynamically stable and comfortable. No complications.

  4. #4
    Default
    Quote Originally Posted by KimberlyAFloyd View Post
    No problem. I'm really thrown off on the SVG. Thanks for responding.

    PROCEDURE
    1. Left heart catheterization.
    2. Saphenous vein graft injection.
    3. Percutaneous coronary intervention with drug-eluting stent to
    distal circumflex.

    INDICATION Unstable angina, borderline troponin.

    PROCEDURE IN DETAIL Risks, benefits, alternatives, goals, possible
    complications, need for team approach were discussed with the
    patient. Informed consent was obtained. A 5-French sheath was
    inserted into right femoral artery under sterile technique. We used
    JL4 Williams right, RCB pigtail to do left heart cath. This showed
    LVEDP 13. No gradient across the aortic valve. Ejection fraction
    50% with inferior wall hypokinesis. Right coronary artery was
    dominant, was 100% occluded proximally. There was a patent saphenous
    vein graft to right PDA that filled antegradely and retrogradely.
    The left main had diffuse 30%, LAD had diffuse 30% disease. The
    proximal circumflex had multiple 20% to 30% lesion. Distal
    circumflex had an 80% focal lesion. In view of the current
    presentation and recurrent hospitalization with the patient, decided
    to go ahead and treat that. Upsized to 6-French sheath, used XB 3.5
    to engage left main, provided good fit and support with a BMW wire
    crossed distally. I advanced a 2.25 x 8 Xience, deployed that at 12
    atmospheres, reduced the lesion in the distal circumflex from 80% to
    0% and TIMI-3 flow was maintained. At the end of procedure, the
    patient was hemodynamically stable and comfortable. No complications.
    It seems to me that you DO have coronaries here in this report as well as SVG. Your codes would be 93459.26.59 and 92980.LC.

    Jessica CPC, CCC

  5. #5
    Default
    I thought he had to select the coronaries and image them in order to get the 93459,26? Am I reading the code description wrong?

    Thank you for your help

    Kim, CPC

  6. #6
    Location
    Barren River, KY
    Posts
    16
    Default
    Kim,

    You would be correct per Dr. Z; the report would need to state "selective coronaries" as the cath codes call for "selective" placement. Do you know whether or not the patient has already been in the hospital and has come back in due to recurrent chest pain and therefore is having the stent done? If this is the case, then you would only code the 92980-LC due to having already known about the stenosis because it sounds as if this could be the case, please see below:

    In view of the current
    presentation and recurrent hospitalization with the patient, decided
    to go ahead and treat that.

    I would look back through and see if this patient has already been in recently and has come back to have this treated.

    If this is not the case, I would quiery the physician and ask them if they done selective coronaries and have them do an addendum so that you could bill 93459-26,59 as well.
    crowmd, CPC

  7. #7
    Default
    The pt hadn't been seen in over a year. I use Dr. Z as well so I thought he would have to select them or at least document that he selected them. I will consult with the Dr on clarification. Thank you for everyone who commented. I really appreciate your help!


    Kim, CPC

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