# Return To Cath Lab...HELP!!!



## brandyleigh23 (Jun 19, 2012)

Can someone help me correctly code the following scenario?

Patient was admitted for chest discomfort, palpitations, and PVC's. Cardiologist decided to proceed with a LHC.  Procedure performed was 93459-26 since the grafts were engaged along with LHC angiogram/LV gram. After LHC doc decided to intervene on the SVG to OM (LC) and procedure performed was 92980-LC

The next day, the patient was having increased levels of chest discomfort, chest pain associated with diaphoresis, and nausea and vomiting. She was also having uncontrolled hypertension with systolic pressure in the 200's. She required increasing doses of IV nitro to relieve her symptoms so she was brought back to the cath lab to have a re-look at her previously placed stents.

Doc states in his "procedure" portion of day 2 dictation:

"A 5 French sheath was inserted into the right femoral artery. Left heart catheterization was performed without any complications. The patient tolerated the procedure well. At the end of the procedure the sheath was removed and hemostais was achieved using manual pressure."   (I do not see anything else in his report that verifies he ACTUALLY performed the LHC..)

In the "findings" he selectively engages the grafts and coronaries. There are no changes in any of these arteries/grafts from the previous day. The only thing different was the selective bilateral renal catheter placements he performed. 

I am thinking I should code the first day with 93459-26/59 and 92980-LC

And the second day with 93455-26/59 and 36252...

Is this correct??  Do I need to add a modifier 79 to relay that an unrelated procedure was performed during the post-op period..? I need some guidance!


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## jewlz0879 (Jun 19, 2012)

I don't think you need a 79 since 93459/92980 have no global days attached. 

I agree with 93455 since no evidence of a true LHC was performed.

Renal artery angiography at the time of cardiac catheterization should be reported as HCPCS code G0275 _*if selective cath of the renal artery(s) is not performed*_. Also, many "selective" renals are not medically necessary (as per LCD's) and are refused for payment, mainly, by Medicare payors. 

HTH


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## brandyleigh23 (Jun 19, 2012)

Thank you so much for your response   I understand what you are saying about the 79 and global days, I wasnt thinking clearly...It makes you feel better to have someone else look at something when you are unsure of yourself!  I do use the G code when an abdominal aortogram with driveby renals is performed for Medicare patients. I am positive from looking at the dicatation that this particular procedure was selective. I appreciate your input and thank you again for your help!


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