# Billing OCT



## amym (Jul 5, 2013)

I got the cath 93458-26-59 and PCI stent 92928-RC but can I bill for OCT 92132?

SUMMARY: 

--  CORONARY CIRCULATION: 
--  RCA: There was a 100 % stenosis in the distal third of the vessel 
segment. The lesion was was associated with a large filling defect 
consistent with thrombus. There was TIMI grade 0 flow through the vessel 
(no flow) and a large vascular territory distal to the lesion. This lesion 
is a likely culprit for the patient's recent myocardial infarction. It 
appears amenable to percutaneous intervention. 

--  CARDIAC STRUCTURES: 
--  Analysis of regional contractile function demonstrated moderate 
anterolateral hypokinesis and severe diaphragmatic hypokinesis. 

--  1ST LESION INTERVENTIONS: 
--  A balloon angioplasty was performed on the 100 % lesion in the distal 
RCA. Following intervention there was a 0 % residual stenosis. 

--  2ND LESION INTERVENTIONS: 
--  A percutaneous intervention was performed on the 50 % lesion in the 
distal RCA. Following intervention there was a 0 % residual stenosis. 

--  RECOMMENDATIONS: 
--  s/p DES RCA X2 2.5x 30 and 2.75x18 postdilated to 3.0 
ASA/Plavix 
LVEDP 25% 
IV diuresis 
Stress vs FFR for LAD lesion 

PROCEDURES PERFORMED: 

--  Left heart catheterization with ventriculography. 
--  Left coronary angiography. 
--  Right coronary angiography. 
--  Hemostasis w/ Angioseal. 
--  PTCA. 
--  Coronary Drug Eluding Stent Placement. 
--  Interventional OCT. 
--  Intervention on distal RCA: balloon angioplasty. 
--  Intervention on distal RCA: percutaneous intervention. 

RECOMMENDATIONS: 
s/p DES RCA X2 2.5x 30 and 2.75x18 postdilated to 3.0 
ASA/Plavix 
LVEDP 25% 
IV diuresis 
Stress vs FFR for LAD lesion 

INDICATIONS: Angina/MI: myocardial infarction without ST elevation 
(NSTEMI), CCS class IV. Congestive heart failure with ischemic 
cardiomyopathy. 

VENTRICLES: Analysis of regional contractile function demonstrated 
moderate anterolateral hypokinesis and severe diaphragmatic hypokinesis. 

CORONARY VESSELS: Left main: There was a 20 % stenosis at the ostium of 
the vessel segment. Proximal LAD: Normal. Mid LAD: There was a tubular 50 
% stenosis. Distal LAD: Angiography showed mild atherosclerosis. 
Circumflex: The vessel was medium sized. Angiography showed severe 
atherosclerosis. 100% occluded dLCX CTO RCA: There was a 100 % stenosis in 
the distal third of the vessel segment. The lesion was was associated with 
a large filling defect consistent with thrombus. There was TIMI grade 0 
flow through the vessel (no flow) and a large vascular territory distal to 
the lesion. This lesion is a likely culprit for the patient's recent 
myocardial infarction. It appears amenable to percutaneous intervention. 
Distal RCA: There was a 50 % stenosis. 

PROCEDURE: The risks and alternatives of the procedures and conscious 
sedation were explained to the patient and informed consent was obtained. 
The patient was brought to the cath lab and placed on the table. The 
planned puncture sites were prepped and draped in the usual sterile 
fashion. 

--  Right femoral artery access. The puncture site was infiltrated with 
local anesthetic. The vessel was accessed using the modified Seldinger 
technique, a wire was threaded into the vessel, and a sheath was advanced 
over the wire into the vessel. 

--  Left heart catheterization. A catheter was advanced to the ascending 
aorta. After recording ascending aortic pressure, the catheter was 
advanced across the aortic valve and left ventricular pressure was 
recorded. Ventriculography was performed using power injection of contrast 
agent. Imaging was performed using an RAO projection. 

--  Left coronary artery angiography. A catheter was advanced to the aorta 
and positioned in the vessel ostium under fluoroscopic guidance. 
Angiography was performed in multiple projections using hand-injection of 
contrast. 

--  Right coronary artery angiography. A catheter was advanced to the 
aorta and positioned in the vessel ostium under fluoroscopic guidance. 
Angiography was performed in multiple projections using hand-injection of 
contrast. 

--  Hemostasis w/ Angioseal.. 

LESION #1 INTERVENTION: A balloon angioplasty was performed on the 100 % 
lesion in the distal RCA. Following intervention there was a 0 % residual 
stenosis. There was no dissection. 

--  Balloon angioplasty was performed, with 1 inflations and a maximum 
inflation pressure of 12 atm. 

--  A Resolute Integrity Rx 2.50 x 30mm drug-eluting stent was placed 
across the lesion and deployed at a maximum inflation pressure of 14 atm. 

--  , using a NC Quantum 3.0 x 15 balloon, with 4 inflations and a maximum 
inflation pressure of 20 atm. 

LESION #2 INTERVENTION: A percutaneous intervention was performed on the 
50 % lesion in the distal RCA. Following intervention there was a 0 % 
residual stenosis. There was no dissection. 

--  A Resolute Integrity Rx 2.75 x 18mm drug-eluting stent was placed 
across the lesion and deployed at a maximum inflation pressure of 15 atm. 

--  , using a NC Quantum 2.75 x 20 balloon, with 4 inflations and a 
maximum inflation pressure of 20 atm. 

CARDIAC INTERVENTIONS 
--  PTCA. 

--  Coronary Drug Eluding Stent Placement. 

--  Interventional OCT. 

COMPLICATIONS: 
There were no adverse outcomes. 
None occurred during the cath lab visit. 

STUDY DIAGRAM 

Angiographic findings 
Native coronary lesions: 
7Left main: Lesion 1: 20 % stenosis. 
7Mid LAD: Lesion 1: tubular, 50 % stenosis. 
7RCA: Lesion 1: 100 % stenosis, large vascular territory. 
7Distal RCA: Lesion 1: 50 % stenosis. 
Intervention results 
Native coronary lesions: 
7balloon angioplasty of the 100 % stenosis in distal RCA. 0 % residual 
stenosis. Stent: Resolute Integrity Rx 2.50 x 30mm drug-eluting. 
7percutaneous intervention of the 50 % stenosis in distal RCA. 0 % 
residual stenosis. Stent: Resolute Integrity Rx 2.75 x 18mm drug-eluting. 

HEMODYNAMIC TABLES 

Pressures:  Baseline 
Pressures:  - HR: 88 
Pressures:  - Rhythm: 
Pressures:  -- Aortic Pressure (S/D/M): 104/70/85 
Pressures:  -- Left Ventricle (s/edp): 113/31/-- 

Outputs:  Baseline 
Outputs:  -- CALCULATIONS: Age in years: 51.64 
Outputs:  -- CALCULATIONS: Body Surface Area: 1.86 
Outputs:  -- CALCULATIONS: Height in cm: 160.00 
Outputs:  -- CALCULATIONS: Sex: Female


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## TWinsor (Jul 7, 2013)

I see the following

92943-RC (note states CTO RCA)
93458-26-59
0291T (OCT code)

HTH!


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## amym (Jul 8, 2013)

Thanks for your help


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