# Subclavian angiogram



## pravintc (Apr 19, 2016)

PROCEDURE PERFORMED:
Left heart catheterization.
Selective coronary angiography.
Selective left subclavian angiogram.

The JR4 catheter was used to perform selective left subclavian angiogram. the catheter was removed over the wire and the sheath was sutured in place. the  left subclavian artery appears to be patent.

The patient will be transferred to another hospital for coronary artery bypass surgery.


I would give 93458 for LHC as the aortic valve was crossed and pressure was recorded, but my doubt is if left subclavian angiogram to be coded or is it bundled?


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## Jim Pawloski (Apr 21, 2016)

pravintc said:


> PROCEDURE PERFORMED:
> Left heart catheterization.
> Selective coronary angiography.
> Selective left subclavian angiogram.
> ...



Since the LIMA will probably be used for bypass surgery, I would bill LHC w/ Bypass Grafts.
HTH,
Jim Pawloski, CIRCC


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## jvilla (Apr 21, 2016)

*You cannot bill for a CABG cath placement when the CABG has not been performed*

Yes, per CPT, "For Internal Mammary angiography performed at the time of cardiac catheterization, see 93455..etc.. which include imaging supervision, interpretation, and report."

However, I see no IMA cath placement, or even that anatomical structure documented.

the LIMA is the Left Internal Mammary Artery, not the Subclavian. The IMA usually arises as the first branch off the inferior aspect of each proximal *subclavian artery*.

The subclavian artery is a first order vessel and selective catheterization would be reported with 3621x (depending where your access point is)

This patient has yet to undergo a bypass. Reporting 93459 would be highly inappropriate. 

I would report this as, based solely on the information provided:
93458-26
36215
75710-26

..of course assuming you have the necessary documentation and necessity..

Jacob A. Villa, CCA, CPC
Kaiser Professional Services Coder II


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## pravintc (Apr 22, 2016)

here is one more scenario for selective left subclavian angiogram and i have coded 93460-26, 36215-LT, 76937-26

please suggest


see attached documents


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