# Impella and Left Heart Caths



## jtuominen (Apr 21, 2009)

Hi there--

One of our docs inserted an impella during a coronary intervention (92970) and Im wondering if this paritulcar case also qualifies for a Left Heart Catheterization as well (93510) since he explains that he took left ventricular pressures, but his dictation confuses me as to whether he took these presssures via the Impella device or a Judkins catheter. Here is how the situation reads:

The area over the right femoral artery was anesthetized using 1% lidocaine.  A 6 French sheath was inserted using modified Seldinger's technique.  Femoral arteriography was then performed from the right side to verify 
adequate vessel in the left side for Impella. 

The area over the left femoral artery was then anesthetized with 1% 
lidocaine.  Artery was cannulated with a single-wall puncture by a 
series of upsize of the sheath.  Ultimately an Impella sheath was 
placed.  A JR-4 was then advanced into the aorta.  Pressures were 
recorded.  Aortic valve was crossed.  Left ventricular pressures were 
recorded.  An exchange wire was advanced into the left ventricle, and 
catheter was then exchanged for the Impella support catheter. 

What do you think?


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## deeva456 (Apr 23, 2009)

Do you commonly bill for the supplies used? If so then you could bill for the impella sheath and catheter. The report supports billing 93510 since the catheter crossed the aortic valve and pressure measurements were taken in the left ventricle.  I would ask your doctor which catheter was used to take the pressure measurements. 

good luck!

Dolores CPC, CCC


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