# Aortic Arch injection



## kdoughty (Sep 28, 2012)

My physicain did an aortic arch injection but I'm not sure I can bill 93567 because of the dx.  Can I bill anything for this or is it included?

   Aortography Injections
     - The pigtail catheter was advanced into the aortic arch and an 
     injection of contrast was performed.

     Aorta and Major Vessels
     - There was mild atherosclerotic plaque of the aortic arch.

Thanks in advance,
Kelly


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## dpeoples (Sep 28, 2012)

klallier said:


> My physicain did an aortic arch injection but I'm not sure I can bill 93567 because of the dx.  Can I bill anything for this or is it included?
> 
> Aortography Injections
> - The pigtail catheter was advanced into the aortic arch and an
> ...



I think this is an arch study, not a study of the aortic root (supravalvular) during a heart cath. I would code 36200/75650 instead of 93567. Also, 93567 can't be billed alone.

HTH


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## kdoughty (Sep 28, 2012)

LHC was done in addition to this so the 36200 would go away, correct?


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## dpeoples (Sep 28, 2012)

klallier said:


> LHC was done in addition to this so the 36200 would go away, correct?



Yes, 36200 goes away with LHC. Is there more to the interpretation/findings? That could change the code.

??


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## kdoughty (Sep 28, 2012)

Here's the full report.

Procedure:            Left Cardiac Catheterization, Left Ventriculography, 
                      Coronary Angiography and Arch Aortography
Indications:          Recurring chest pain with negative stress testing. 
                      Shortness of breath.
Providers:            
Referring MD:         
Procedure Medications:
     Isovue 409 mL.
     Total IV Fluids Administered
     - IV Fluids: 0.9NaCl IV started @ kvo ml/hr IV Fluids
     Oxygen: Started @ 2 L/min via nasal cannula
     Midazolam (Versed) 2 mg IV.
     Fentanyl (Sublimaze) 50 mcg IV.
     Local Anesthetic to right groin 19 ml Lidocaine 2% >Initial mL, local 
     infiltration.
     Oxygen: Increased to 4 L/min via nasal cannula
     Oxygen: Increased to 6 L/min via nasal cannula
     Total Diag Contrast: Isovue 409 ml's
     Total Proc Contrast: Isovue 409 ml
Complications:        No immediate complications.
Patient History:
     PROCEDURE 2 Aortic Root
     Pt Status: Admission Status: Outpatient Referral
     Pt Status: Patient Admission Type >> Outpatient
     Pt Status: Cath Status: Elective
     Pt Status: PCI Status: Elective
     Pt Status: Insurance Payor: Commercial
     Hx/Risk Factors: BP Problems: Hypertension
     Hx/Risk Factors: R/O CAD - Stress Test: Yes Positive
     Hx/Risk Factors: Chest Pain/Angina
     Previous Procedures: NONE
     ALLERGIES: NKDA
     Beta Blocker-Beta Blocker > Yes
Description of Procedure:
     Approach:
     - Right femoral artery. Access method: Percutaneous puncture.
     Fluoroscopy
     - Fluoroscopy time: 13.6 minutes.
     Devices Used
     - Boston Scientific Fixed Core 3mm J .035" 145 cm
     - Boston Scientific 5 Fr. FL 4.0 cm
     - Boston Scientific 5 Fr.Fr 4.0 cm
     - Boston Scientific 5 Fr. Pigtail Straight
     - Terumo Standard 5 Fr.
     - Boston Scientific 5 Fr. IMA Regular
     - Boston Scientific 5 Fr. AL 1.0
     - Boston Scientific 5 Fr. AR 1
     - Boston Scientific 5 Fr. MP A2 - 100 cm
     - Cordis Standard 6 Fr.
     - Mynx
     - 6Fr CLS 3.0 Boston Scientific RunWay
     - 6Fr Hockey stick Boston Scientific RunWay
     - 6Fr IMA Boston Scientific RunWay
     - Namic 12 cc Control
     Closure
     - At the conclusion of the procedure, the right femoral artery sheath 
     was removed.
     - Hemostasis was obtained with the Mynx.
Findings/Interventions:
     Left Ventriculography
     - The overall left ventricular systolic function was normal. Left 
     ventricular ejection fraction was 55-60%.

     Left Main Coronary Artery
     - There were no obstructing lesions in the left main coronary artery. 
     Blood flow appeared normal.

     Left Anterior Descending Artery
     - There was a 30 to 40% discrete stenosis in the proximal left anterior 
     descending artery. The proximal LAD had vasospasm during injection 
     relieved with nitroglycerin.

     Left Circumflex Artery
     - There was a 30% discrete stenosis in the proximal left circumflex 
     artery.

     Right Coronary Artery
     - Anomalous origin off the left coronary cusp. The right coronary artery 
     was dominant to the posterior circulation. There was a 30% discrete 
     stenosis in the mid right coronary artery. There was a 30% discrete 
     stenosis in the distal right coronary artery.

     Aortography Injections
     - The pigtail catheter was advanced into the aortic arch and an 
     injection of contrast was performed.

     Aorta and Major Vessels
     - There was mild atherosclerotic plaque of the aortic arch.
Impression:
     Minimal atherosclerotic coronary artery disease.
     Anomalous origin of the RCA off the left coronary cusp.
     Vasospasm of the proximal LAD during angriography.
     The left ventricular ejection fraction was 55-60%.
     The overall left ventricular systolic function was normal.
Measurements:
     VITALS
     Arm Cuff Blood Pressure: 102 / 66 mmHg
     O2 Sats: 98 %
     Respiratory Rate: 8 r/min
     Heart Rate: 57 /min
     HEMODYNAMIC DATA
     Left Ventricular Ejection Fraction: 55-60%
     OXYGEN SATURATION
     O2 Estimated: 263.34 % 02
     ARTERIAL PRESSURE DATA
     Aorta Pressure: 93 / 46 mmHg
     Left Ventricle Systolic Pressure: 96 mm(hg)
     Left Ventricle Diastolic Pressure: 18 mm(hg)
     Left Ventricle End Diastolic Pressure: 28 mm(hg)
     Aorta Mean Pressure: 66 mm(hg)
     VENOUS DATA
     Systemic Venous Hemoglobin: 14
     LABS
     Hemoglobin: 14
Recommendation:
     Optimal medical therapy of the patient's disease, including 
     anti-vasospastic therapy.
     Aggressive risk factor modification.


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## dpeoples (Oct 2, 2012)

klallier said:


> Here's the full report.
> 
> Procedure:            Left Cardiac Catheterization, Left Ventriculography,
> Coronary Angiography and Arch Aortography
> ...



The phrase "major vessels' had me thinking "arch vessels" (carotids, subclavian arteries etc). This was not correct per this report. Please ignor my previous post. I would code this:
93458 for the LHC and 93567 for the aortic root injection (not an arch study even though the arch is seen).

HTH


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## kdoughty (Oct 2, 2012)

Thanks a ton!!


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## theresa.dix@tennova.com (Oct 3, 2012)

klallier said:


> Thanks a ton!![/QUOTE
> 
> Danny is exactly right. I agree.


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