# Cardiac catheterization report



## jonyleo20 (May 18, 2012)

CARDIAC CATHETERIZATION REPORT

DATE OF PROCEDURE:   05/16/2012

REFERRING PHYSICIAN:
PROCEDURE:
1. Right heart catheterization.
2. Left heart catheterization.
3. Right iliofemoral angiogram.
4. Supravalvular aortogram.
5. Angio-Seal closure device placement.

BRIEF HISTORY AND INDICATION:
Patient is a 75-year-old male with a history of aortic
insufficiency. I have been asked to perform right and left heart
catheterization as well as aortography prior to consideration for
cardiac surgery.

All risks, benefits, and alternatives were discussed at length with
the patient. Patient refuses anything other than diagnostic testing
today. Refuses intervention. Refuses intracoronary evaluation.

RIGHT HEART CATHETERIZATION FINDINGS:
1. Right atrium - mean 11 mmHg.
2. Right ventricle - 32/10.
3. Pulmonary artery - 32/19 with a mean 23 mmHg.
4. Pulmonary capillary wedge - mean 19 mmHg.
5. Cardiac output - 4.6 L/minute.

LEFT HEART CATHETERIZATION FINDINGS:
1. Left main - the left main coronary artery has luminal
   irregularities and minor eccentric plaque at the origin with no
   significant focal stenosis.
2. Left anterior descending - the LAD is a moderately calcified
   vessel in its proximal segment. This proximal segment has an
   approximate 60 percent stenosis. This is an ectatic diffusely
   diseased vessel with sluggish flow distal to the lesion. The main
   diagonal branch has luminal irregularities only and no significant
   focal obstruction.
3. Left circumflex - the left circumflex artery and its marginal
   branches have luminal irregularities throughout but no significant
   focal obstruction.
4. Right coronary artery - the RCA has luminal irregularities
   throughout its course and is also an ectatic vessel in its
   proximal segment, but has no significant focal stenosis. The RCA
   is the dominant vessel.
5. Left ventricle -
   a. End diastolic pressure 17 mmHg.
   b. Ejection fraction visually estimated at 50-55 percent.
   c. No aortic stenosis.
   d. No significant mitral regurgitation is seen.
6. Supravalvular aortogram - normal system. No aneurysm. No
   dissection. No significant aortic insufficiency seen.
7. Right iliofemoral angiogram - normal visualized system. Minimal
   atherosclerosis. Sheath enters at an appropriate level. An
   Angio-Seal closure device was placed achieving hemostasis.

ASSESSMENT:
1. Essentially normal intracardiac pressures.
2. Coronary artery disease with borderline stenosis in the proximal
   to mid left anterior descending (LAD).
3. No significant valvular abnormalities seen.




     Can someone please give me an insight on how to code this report .

thx


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## WendyLWest (May 18, 2012)

*Cardiac Cath Report*

I would code the cath procedure as 93460 and 93567 for sure.  Now my question is for the iliofemoral angio.  I'm assuming it would be the extremity angio which would be 75710 but the documentation on this is really not that clear.  So this is how I came up with the codes.  93460 which is the Right and Left heart cath codes with the coronories.  This code also is used if the LV gram is done which it looks to me that this was done on the example.  The left heart cath is verified by the 1. documentation of the report.  The coronaries are addressed by numbers 2,3 and 4.  You can pick up the Right heart cath by the findings that are listed.  The LV is listed with number 5.  Number 6 is for the supravalvular aortogram 93567 and the extremity angio is listed under number 7.  You will need to modify the diagnostic extremity exam but I hope this helps!


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## dpeoples (May 21, 2012)

jonyleo20 said:


> CARDIAC CATHETERIZATION REPORT
> 
> DATE OF PROCEDURE:   05/16/2012
> 
> ...




I would code 93460 and 93567.
I would not code for the ileofemoral angiography. That was performed to evaluate the access/closure site and should not be separately reported, IMO.

HTH


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## jonyleo20 (May 21, 2012)

I really appreciate it . Thank you very much.


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## jonyleo20 (May 21, 2012)

I'm very confuse about these two CPT Codes 93457, and 93461.  Can someone please clearify that for me. I have the Opt Report just incase you want to read it.

Thanks in advance.


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## Jim Pawloski (May 22, 2012)

jonyleo20 said:


> I'm very confuse about these two CPT Codes 93457, and 93461.  Can someone please clearify that for me. I have the Opt Report just incase you want to read it.
> 
> Thanks in advance.



93457 is for Coronary Angiography with bypass grafts, and right heart cath.  93461 is for left and right heart cath with coronaries and bypass grafts.  So the only difference is did a catheter go into the left ventricle and pressures reported.  If not 93357, if the catheter did go into the LV then 36461.

HTH,
Jim Pawloski, CIRCC


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