# CPT 93452 versus 93458



## southpawiv@gmail.com (Aug 6, 2015)

Hello, 

Our coders are at odds as to what CPT code is most appropriate for the scenario below. Can any of you cardiac cath coders give your insight? It would be greatly appreciated. 

Description of Test:  Invasive Cath Procedure

Clinical Summary:  The patient is 62-year-old white female who presented with a non-Q-wave MI with longstanding tobacco abuse. 

Hemodynamic Data:  The AO pressure 124/65 with a mean of 90. The LV systolic blood pressure 121 with an LVEDP of 15.

Angiographic Summary:
1) The left ventricle is visualized in the 30-degree RAO projection demonstrates akinesia of the anterolateral wall with the rest of the ventricle contracting normally. Estimated ejection fraction of 40%. 
2) The left main coronary artery appears to be free of significant disease bifurcating into moderate size LAD system, moderate size circumflex system. Circumflex courses in the AV groove where it gives rise to 1 proximal obtuse marginal branch and demonstrates mild plaquing. It continues to course in the AV groove giving rise to 2 posterolateral branches, the 1st of which has a high-grade stenosis in its proximal portion and the 2nd of which demonstrates mild plaquing. The left anterior descending coronary artery courses the interventricular groove, giving rise to the usual complement of septals, terminating at the apex of the heart in a small mermaid's tail. The LAD gives rise to 1 proximal diagonal branch of moderate size, a number of very small mid and distal diagonal branches. The LAD just after the takeoff of the 1st diagonal branch has a long segmental area of stenosis of up to 70%. The diagonal branch itself is subtotally occluded. Right coronary artery is anatomically non-dominant with a subtotal occlusion in its proximal portion of up to 70%. 

CONCLUSION:  
1) Resting left-sided hemodynamics reveal a mildly non-compliant left ventricle with a LVEDP of 15.
2) There is moderate left ventricular dysfunction as described with anterolateral akinesia. 
3) There is 3-vessel native coronary disease as described. Long segmental area of disease in the proximal mid LAD, subtotal occlusion of the diagonal branch, high-grade stenosis of the posterolateral branch. 

Thank You, 
Nicole


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## rebec26@juno.com (Aug 6, 2015)

southpawiv@gmail.com said:


> Hello,
> 
> Our coders are at odds as to what CPT code is most appropriate for the scenario below. Can any of you cardiac cath coders give your insight? It would be greatly appreciated.
> 
> ...




By the findings it appears to be 93458 but there is no description of the procedure that was done. Thanks


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## MARCYL (Aug 7, 2015)

on page 591 of the 2015 cpt book is a chart for the caths   that should help with any questions for which code is the best to use


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