# 93459+92920?



## amym (Jun 10, 2013)

We have billed this as 93459-26-59, 92920-RC, 92920-LM, is that appropriate? -Thanks in advance.

SUMMARY: 

--  CORONARY CIRCULATION: 
--  Distal left main: There was a diffuse 30 % stenosis at the site of a 
prior stent, in the middle third of the vessel. There was TIMI grade 3 
flow through the vessel (brisk flow). This is a likely culprit for the 
patient's clinical presentation. An intervention was performed. --  Right 
PDA: There was a discrete 100 % stenosis at the site of a prior stent, in 
the middle third of the vessel segment. There was TIMI grade 0 flow 
through the vessel (no flow). This lesion is a likely culprit for the 
patient's anginal symptoms. An intervention was performed. 

--  CARDIAC STRUCTURES: 
--  EF was not assessed. 

--  1ST LESION INTERVENTIONS: 
--  A balloon angioplasty was performed on the 100 % lesion in the distal 
RCA. Following intervention there was a 0 % residual stenosis. 

--  2ND LESION INTERVENTIONS: 
--  A balloon angioplasty was performed on the 40 % lesion in the left 
main. Following intervention there was a 0 % residual stenosis. 

PROCEDURES PERFORMED: 

--  Left heart catheterization with ventriculography. 
--  Left coronary angiography. 
--  Right coronary angiography. 
--  Saphenous vein graft angiography. 
--  Coronary Angioplasty. 
--  Interventional IVUS. 
--  Intervention on distal RCA: balloon angioplasty. 
--  Intervention on left main: balloon angioplasty. 

INDICATIONS: Angina/MI: unstable angina. 

HEMODYNAMICS: Hemodynamic assessment demonstrates normal hemodynamics. 

VENTRICLES: EF was not assessed. 

CORONARY VESSELS: The coronary circulation is right dominant. Left main: 
There was a 40 % stenosis. Distal left main: There was a diffuse 30 % 
stenosis at the site of a prior stent, in the middle third of the vessel. 
There was TIMI grade 3 flow through the vessel (brisk flow). This is a 
likely culprit for the patient's clinical presentation. An intervention 
was performed. Proximal LAD: The vessel was normal sized. Angiography 
showed no evidence of disease. Mid LAD: Angiography showed minor luminal 
irregularities. Distal LAD: Angiography showed minor luminal 
irregularities. Proximal circumflex: There was a 100 % stenosis. Proximal 
RCA: Normal. Mid RCA: Normal. Distal RCA: Normal. There was a 100 % 
stenosis. Right PDA: There was a discrete 100 % stenosis at the site of a 
prior stent, in the middle third of the vessel segment. There was TIMI 
grade 0 flow through the vessel (no flow). This lesion is a likely culprit 
for the patient's anginal symptoms. An intervention was performed. 

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. 

LESION #1 INTERVENTION: A balloon angioplasty was performed on the 100 % 
lesion in the distal RCA. Following intervention there was a 0 % residual 
stenosis. 

--  Vessel setup was performed. A BMW HT 190cm wire was used to cross the 
lesion. 

--  Vessel setup was performed. A Runway 6FR FR4 SH guiding catheter was 
used to cannulate the vessel. 

--  Balloon angioplasty was performed, using a Sprinter 1.5 x 12 balloon, 
with 1 inflations and a maximum inflation pressure of 15 atm. 

--  Balloon angioplasty was performed, using a NC Sprinter 2.5 x 6 
balloon, with 2 inflations and a maximum inflation pressure of 22 atm. 

LESION #2 INTERVENTION: A balloon angioplasty was performed on the 40 % 
lesion in the left main. Following intervention there was a 0 % residual 
stenosis. There was no dissection. 

--  Balloon angioplasty was performed, using a NC Sprinter 5.0 x 15 
balloon, with 3 inflations and a maximum inflation pressure of 20 atm. 

CARDIAC INTERVENTIONS 
--  Coronary Angioplasty. 

--  Interventional IVUS.


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## CPCCODERII (Jun 11, 2013)

I agree with your coding, but I would also add 92978 for the IVUS.  That is an add on code and can be billed at the time of a heart catheterization.  I like the detailed documentation your providers give!  Very easy to follow


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## amym (Jun 11, 2013)

Thanks


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