# Help in coding a diagnostic coronary angiogram



## MGASKILL (Sep 27, 2010)

This is my first coding experience with this procedure. Please help. Notes are below.



Procedure(s):

Coronary Angiography
ps/ao/cor
vent/atrial
Coronaries NO V-Gram

Indications: Chest Pain

Diagnostic Technique:  After obtaining informed consent, the Right Groin wasa anesthetized using Lidocaine 2%. Intravascular access was established via the Right Femoral Artery using the modified Seldinger technique. A 6 French sheath was placed over the wire. LCA angiography visualized with JL 4.0 in multiple views. RCA angiography visualized with JR 4.0 in multiple views. Pressures were recorded across the aortic valve using a pigtail catheter. LV gram not performed because of elevated EDP. The sheath was secured to be pulled in recovery.

Contrast: Omnipaque 50mL

Procedural Med
Versed 1 mg IV pre-pro
Versed 1 mg IV pre-pro
Fentanyl 50mcg IV pre-pro
Fentanyl 25mcg IV pre-pro
Versed 1 mg IV pre-pro
Fentanyl 25mcg IV pre-pro
Versed 1 mg IV during
Fentanyl 50mcg IV during
Morphine 1 mg IV during
Notroglycerin 0.4 mg SL  during

No complications.

State: RM AIR REST

Coronary Dominance: Right

Findings:
*Left Main Coronary Artery - The LMCA is normal and is short.
* Left Anterior Descending - Proximal LAD is normal. The MId LAD has mild luminal irreg. w/ 30% stenosis. The Distal LAD is normal. The 1st Diagonal is normal as well as the mid and distal vessel. The 2nd Diagonal is small. The 3rd Diagonal is small.
*Circumflex - The Proximal Circumflex has mild luminal irreg. w/ 20% stenosis. The 1st Marginal has diffuse luminal irreg. w/ 50% stenosis.
*Right Coronary Artery - The Mid RCA has mild luminal irreg. w/ 20 - 30% stenosis before the RV branch and 30 - 40% after the RV Branch. The Right PDA is normal. The 1st RPL is normal. The 3rd RPL is normal.


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## pgansberger (Sep 27, 2010)

*Help in coding diagnostic coronary angiogram*

93508-26 Catheter placement in coronary artery(s), arterial coronary conduit(s), for coronary angiography without concomittant left heart catheterization. 
93545  Injection procedure during cardiac catheterization for selective coronary angiography
93556-26 Imaging supervision, interpretation and report for injection procedure; selective coronary angiography

Pat Gansberger, CPC CCC


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## MGASKILL (Sep 27, 2010)

*diagnostic coronary angiogram*

Thanks. You are a life saver.


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## KeriH423 (Sep 28, 2010)

I agree with Pat, but I want to explain why since this is your first cardiac cath.  Your note states that pressures were recorded across the aortic valve, but I don't see them listed in the note.  If the physician had listed LVEDP, aortic valve gradient, systolic, or diastolic pressures, 93510 should be charged versus 93508.  Left ventriculography is tied to 93543 and 93555, not 93510.

What I wanted to make clear was that you can have a left heart cath performed without the left ventriculography being done and this happens pretty routinely. When patients have known chronic renal disease to avoid overloading them with contrast, they won't inject the LV but they still obtain pressures.  In this instance, the code set would be 93510-26, 93545, 93556-26.  I hope this makes sense!  

Keri H., CIRCC


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## MGASKILL (Oct 1, 2010)

*diagnostic coronary angiogram*

Where can I find more help in coding guidelines for this type of procedures? I have signed up for a training class but need all the info I can gather.

Thanks for your help.

Mg


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