# Left and Right Heart Cath



## em2177 (Mar 7, 2012)

Help coding this scenario.... I do not see the Left and Right Heart Cath in the report.  

PREOPERATIVE DIAGNOSIS:
Moderately severe mitral regurgitation.

POSTOPERATIVE DIAGNOSIS:
Moderately severe mitral regurgitation.

PROCEDURE PERFORMED:
1. Left and right heart catheterization.
2. Selective left and right coronary angiography.
3. Left ventriculogram.

INDICATIONS:
The patient is a 79-year-old female who has had moderate to severe
mitral regurgitation diagnosed on echocardiogram and transesophageal
echocardiogram. There is significant mitral valve prolapse of both
leaflets. There are 2 distinct jets in the mitral valve.

DESCRIPTION OF PROCEDURE:
The patient was consented. The patient was brought to the cardiac
catheterization laboratory. The patient was prepped and draped in
usual sterile fashion. Xylocaine 1% was administered to the right
femoral region. A 7-French sheath and catheter was inserted into the
right common femoral artery, a 7-French sheath into the right common
femoral vein. A 7-French Swan-Ganz catheter was placed into the
right pulmonary artery and pulmonary catheter wedge pressure and
pulmonary artery pressures were measured. Cardiac outputs were
measured x3. Subsequently, the Swan-Ganz catheter was then removed,
and as the Swan-Ganz catheter was removed, right ventricular pressure
and right atrial pressure were measured. After this, a 7-French
pigtail catheter was inserted into the left ventricle. Left
ventriculogram was performed in biplane fashion. Subsequently, the
pigtail catheter was removed from the patient. A 7-French JL 5
diagnostic catheter was inserted and left coronary angiogram
performed. Subsequently, a right Williams catheter was inserted.
Attempt was made to engage the right coronary artery, but this was
unsuccessful. Therefore, a 7-French AL-2 diagnostic catheter was
inserted and was engaged to right coronary artery and right coronary
angiogram performed. Subsequently, the catheter was removed from the
patient. Right iliofemoral injection took place, after which
Perclose device was used for complete hemostasis to the right common
femoral artery. Pressure was held for hemostasis for the right
common femoral vein and then FemoStop applied. Patient tolerated the
procedure well without immediate complications.

FINDINGS OF PROCEDURE:
HEMODYNAMIC DATA:  Pulmonary artery pressure 40/20. Pulmonary
capillary wedge pressure 18 mmHg. Right atrial pressure 11 mmHg.
Cardiac output 4.8 liters/minute. Coronary arteries angiographically
normal. Left main artery is a long without significant disease. LAD
angiographically normal. Circumflex artery angiographically normal.
Right coronary artery takes off more anteriorly. The patient's right
coronary artery has an anomalous takeoff more anteriorly; however, no
significant disease.

Left ventriculogram shows overall left ejection fraction of 50%-55%
without segmental wall motion abnormality. There is definite
significant mitral valve prolapse of both leaflets with 3+ mitral
regurgitation.

IMPRESSION:
1. Moderately severe mitral regurgitation.
2. Elevated pulmonary capillary wedge pressure as well as right
   atrial pressure.
3. Moderate pulmonary hypertension.
4. Coronary arteries without significant disease.
5. Significant mitral valve prolapse noted on left ventriculogram
   with preserved overall left systolic function.

PLAN:
Patient will be considered for mitral valve replacement.


----------



## Jess1125 (Mar 7, 2012)

em2177 said:


> Help coding this scenario.... I do not see the Left and Right Heart Cath in the report.
> 
> PREOPERATIVE DIAGNOSIS:
> Moderately severe mitral regurgitation.
> ...



You DO have a right/left heart cath here, 93460. The patient had a left ventriculogram done which tips off to you that a left heart cath was performed. Provider can't get into the left ventricle without crossing the aortic valve. Also there are right heart pressure measurements here as well so the right heart cath was done as well. 

Jessica CPC, CCC


----------



## kevbshields (Mar 7, 2012)

The pulmonary artery pressures also indicate a right heart cath.  Almost any time you have hemodynamics with recordings, you'll have a heart cath.

I concur, coronary angiography with left and right heart caths.


----------



## em2177 (Mar 7, 2012)

If the physician is performing a Left and Right Heart Cath with Coronary Angio but "NO LV ANGIO" what would be the code? 
The code 93458 includes the LV angio.....


----------



## donnajrichmond (Mar 7, 2012)

em2177 said:


> If the physician is performing a Left and Right Heart Cath with Coronary Angio but "NO LV ANGIO" what would be the code?
> The code 93458 includes the LV angio.....



Look carefully at the code description - "including intraprocedural injection(s) for left ventriculography, when performed".
Not doing an LVgram does not negate the code.


----------

