# Cardiac cath w/ abdominal aortography



## slwitt (Aug 28, 2008)

We just started coding for a cardiologist, please advise me how to assist him with his documentation and coding. We are receiving frequent denials for his Cardiac Cath billing.

PROCEDURE DONE
1. Left heart catheterization.
2. Selective coronary angiography.
3. Left ventriculogram. 
4. Abdominal aortogram.

PROCEDURE
1. A 6-French short catheter sheath was in place in right femoral artery without difficulty.
2. A 6-French catheter was utilized.
3. The patient tolerated the entire procedure very well and there was no immediate procedure-related complication. 
4. Right femoral arterial puncture site was closed with a closing device, Angio-Seal, after the arterial patency was documented. Good pedal pulse afterward. 

COMMENTS ON CORONARY ANGIOGRAPHY
1. Main trunk of left coronary artery is practically not existent as almost separate origin of LAD and circumflex branch of left coronary artery. 
2. Wide open entire length of left anterior descending branch, including diagonal branches.
3. Circumflex branch was a rather large, single branch which was wide open.
4. Right coronary artery was wide open as well. 

COMMENTS ON LEFT VENTRICULOGRAM
1. Normal left ventricular end-diastolic volume. 
2. Normal left ventricular contractility with estimated left ventricular ejection fraction of 60%. 
3. No evidence of mitral valve prolapse or mitral insufficiency. 

COMMENTS ON HEMODYNAMICS
1. Normal left ventricular end-diastolic pressure, 9 mmHg. 
2. No pressure gradient across the aortic valve in a pull-back pressure recording. 

COMMENTS ON ABDOMINAL AORTOGRAM
1. Normal appearance of entire abdominal aorta. 
2. Grossly patent bilateral renal arteries, bilateral iliac arteries, and bilateral common femoral arteries. 

SUMMARY
1. Wide open bilateral coronary arteries.
2. Normal left ventricular contractility.
3. No evidence of mitral or aortic valve disease.
4. Normal left heart hemodynamic findings.
5. Normal abdominal aortogram

This was performed as outpt hospital so I coded 93510-26, 93555-26, 93556-26, 93543, 93545. The physician believes he also has a 75625 Abdominal Aortography. But in reviewing the CCI edits this would not be coded unless  the procedure could stand alone as if the Cardiac Cath was not performed. Since this is the first time we are actually reviewing his documentation I would appreciate any coding direction from your experiences.


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## Joan Prisco (Aug 28, 2008)

Why 93556?


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## slwitt (Aug 29, 2008)

For the coronary angiography and the aortography Imaging supervision  I & R.


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## Erika95 (Sep 3, 2008)

If you have time to call me at work tomorrow. I have l few websites that I know will assist you along with some other information that helped me.
Call anytime between 8-4 tomorrow.   
My #337-377-8162 Erika 


Erika Anderson CPC
Lake Charles Medical & Surgical Clinic
eanderson@lcmsc.com
(337)312-8304


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## Anna Weaver (Sep 4, 2008)

*with aortography*

I would also code the 93544 injection for aortography. check this and see if it might be what your looking for.


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## billiek (Sep 4, 2008)

I don't see that aortography(93544) was done.  I would code the cath with 75630-59, as he dictated findings for the abdominal area as well as the iliacs


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## cweavercpc (Sep 11, 2008)

*75630-59*

I agree with billiek.... we currently bill the 75630-59 and get paid !!!


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## slwitt (Sep 12, 2008)

You have advised he is missing the documentation of the aortography           (93544), is it because of the procedure description or the interpretation? What type of documentation would he need to add?


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## scorrado (Sep 12, 2008)

We bill 75625/26 and have not had any issues.


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