# difference between left heart catheterizaton and right heart catheterization



## vinodkumartc (May 8, 2018)

I am working as medical coder i have a doubt regarding cardiac catheterization.  my question is what is the difference between left heart catheterization and right heart catheterization. when physician will go for left heart catheterization or right heart catheterization. can anyone clarify my doubt.


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## ljones88 (May 9, 2018)

When I first started coding cardiac caths I found the description below to help me. Also the physician can perform a combined left/right heart cath with or without coronary angiography. Rt/Lt w/out angiography is 93453, and Rt/Lt w/ angiography is 93460. Then there are a few codes that can be reported when they also enter any bypass grafts (93459 or 93461). In the operative report there should be documentation of the hemodynamics that will (or should) include some type of documentation mentioning the Right Ventricular pressures or the Left Ventricular pressures. 

Diagnostic right heart catheterization allows one to measure the pressure in the right side of the heart. Conditions such as pulmonary hypertension can be diagnosed this way and also, valvular heart disease can also be diagnosed using right and left heart catheterization. 

With left heart catheterization, the cardiologist is focusing on the pumping chamber of the heart. A ventriculogram shows the contractility of the left ventricle of the heart and again, with left heart catheterization, that’s also coupled often with coronary angiography where the cardiologist will take pictures of the coronary arteries to look for blockages

*From Encoder Pro the description of a right heart cath (93451 for example) states:* The physician threads a catheter to the heart, most frequently through an introducing sheath placed percutaneously into the femoral vein. However, the physician may elect to use the subclavian, internal jugular, or antecubital vein instead. *The catheter is threaded into the right atrium, through the tricuspid valve into the right ventricle, and across the pulmonary valve into the pulmonary arteries. ECG monitoring for the entirety of the procedure is included, as are intracardiac or intravascular pressure recordings, cardiac output and oxygen saturation measurements, and final evaluation and procedure report. This code applies to catheterizing the heart's right side only*

*From Encoder Pro the description of a left heart cath (93452 or 93458(lt hrt cath w/ angiography) for example) states:* The physician threads a catheter to the heart, most frequently through an introducing sheath placed percutaneously into the femoral, brachial, or axillary artery using retrograde technique. *Using this technique, the catheter passes through the aortic valve into the left ventricle. Intracardiac and intravascular pressures are recorded. Left ventricular injections may be performed for left ventriculography; the physician injects dye through a previously placed catheter threaded through a central line into the left ventricle or atrium to evaluate function with fluoroscopy. * Imaging supervision and interpretation, when performed, are included in this code, as is any required repositioning of catheters.

Medtronic published a useful PDF that I use often that helps summarize the most common cath and PCI procedures. It's from 2016 but luckily these codes haven't been changed or deleted since then. The link: https://www.medtronic.com/content/d...t/cardio/documents/coronary-coding-sheet2.pdf 

Also, Dr. Z is practically the IR guru and I immediately signed up for his membership site to learn vascular and cardiac cath coding. The lowest membership (which is what I have) is about $25/mo, you have access to every single "Ask Dr Z" question and answer, submit one question per month to Dr. Z staff, and a slew of other benefits. I found that 99% of the questions I had were already asked by other members so it was super convenient to find my answers. He goes into pretty deep detail with his rationale. His link: http://zhealthpublishing.com/zmembership/account/index/

I should mention that the codes mentioned above are for non-congenital conditions. If the patient undergoes cardiac cath for a congenital condition (Q dx codes), the codes are different. That pdf lists the various congenital and non-congenital cardiac cath codes and add on procedures. The main thing to keep in mind is take your time reading those op reports cause it's easy to miss key verbiage that would result in an add-on.


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