# Attempt at cardiac cath



## amym (Mar 22, 2012)

Please help with coding:

An attempt at cardiac cath was made.  A femoral approach was first attempted.  Xylocaine was used to infiltrate the skin in the right femoral area.  Arterial and venous accesses were obtained.  A 4 and 5-French sheath were inserted into the venous and femoral vessels respectively.  Versed 32 and 25 fentanyl was given through the venous sheath.  A judkins catheter was then used to try and go up the aorta, however, in the mid descending aorta just above the iliacs there was significant resistance.  A contrast injection suggested that the catheter may have gotten in the dissection plane despite multiple attempts with other catheters, it would not advance.  The procedure was aborted

A right radial approach was attempted.  Xylocaine was used to infiltrate the skin in the right radial area.  Arterial access was easily obtained and a 5-French sheath was inserted.  Once again, a Judkins catheter was used to try and go up the vessel but at the mid subclavian region there was resistance.  Contrast injection showed 100% occlusion of the subclavian vessel.  The radial artery procedure was therefore aborted and one final attempt was made to try and access from the femoral area.  The guidewire would not advance beyond the descending aorta just above the iliac bifurcation.  A contrast injection showed that the iliacs themselves were widely patent with just mild atherosclerosis.


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## dimmitta (Mar 26, 2012)

I would say that since you never even got close to doing a heart cath, you would have to code what was done. So I would code the catheterization and diagnostic pictures taken in the leg and the arm. Hope this helps!


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## amym (Apr 10, 2012)

36140 and 75716-26?


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## dimmitta (Apr 11, 2012)

If this is the whole cath report I would bill:

36000 (cath placement vein)
36200 (cath placement aorta)
36120 (cath placement right subclavian)
75710 (diagnostic picture right arm)

I would not bill 75716 because I do not see information regarding bilateral extremities. If there was documentation for bilateral legs I would be inclined to bill 75630 for the abdominal aortography with iliofemoral run-off. 

Hope this helps


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