# Heart Cath, Coronary Stent, and Angiography



## ladonnaalexis (Oct 7, 2010)

Just need a little help with this.  UHC denied a claim stating medical documentation only shows the findings and does not show the detailed report.  Has anyone had these issues and do you think the following are appropriate codes for the procedure?

93510 26, 93543, 93545, 93555 26 59, 93556 26 59, 36245 50 51, 75724 26 59, 75630 26 59, 36245 59 51, 36246 59, 75726 26 59, 92980 RC

 Procedure:
1. Left Heart Cardiac Catherization
2.  Left ventricular angiogram.
3.  Bilateral selective renal angiogram.
4.  Abdominal aortic angiogram with runoff.
5.  Bilateral selective iliac angiogram.
6. Angioplasty and stenting of the right coronary artery.

PROCEDURE IN DETAIL:
After informed consent, the patient was brought to the cardiac catherizatin table.  Both groins were prepped and drapped in a sterile manner.  We used 2mg of Versed and 25mg of fentanyl for sedetation.  We infiltrated the right groin with 2% Xylocain and placed a 6-French sheath in the right femoral artery after a single front wall stick.  We used a JL4 catheter to cannulate the left main coronary artery.  We used a JR4 catheter to cannulate the right coronary artery.

RESULTS OF SELECTIVE CORONARY ANGIOGRAM:
1.  LEFT MAIN:  The left main is an average size vessel with no significant disease.
2.  LEFT ANTERIOR DESCENDING:  The left anterior descending artery is a large vessel.  The proximal to mid segment of the left anterior descending has moderate calcification.  The diagonal one appears to have 70% stenosis.  The mid left anterior descending has 40-50% long calcified lesion but no critical disease.
3.  LEFT CIRCUMFLEX:  The left circumflex artery has no critical disease.  The obtuse marginal one has 70% long proximal to mid sement of stenosis.
4.  RIGH CORONARY ARTERY:  The right coronary artery is a large, dominant vessel.  The distal right coronary artery has a discrete calcified 70% stenosis.  It bifurcates into the posterolateral and posterior descending artery.  The posterior descending artery has diffusely diseased chronic subtotal apperance.  The posterolateral branch also has a long 70% stenotic lesion with both posterior descending artery and posterolateral are small caliber vessels.

RESULTS OF LEFT VENTRICULAR ANGIOGRAM:
Left ventricual ejection fraction is approximately 50% with left ventricaul end-diastolic pressure approximately 7 mmHG.

RESULTS OF ABDOMINAL AORTIC ANGIOGRAM WITH RUNOFF:
No critical disease in the bifurcation of the abdominal aorta noted.

RESULTS OF BILATERAL SELECTIVE RENAL ANGIOGRAM:
No critical disease in both renal arteries.  No significant renal artery stenosis.

RESULTS OF BILATERAL SELECTIVE ILIAC ANGIOGRAM:
1.  LEFT LOWER EXTREMITY ANGIOGRAM:  No significant disease in the left common iliac, external iliac, left common femoral artery, superficial femoral artery and popliteal artery noted.  There is two-vessel flow dow to the left ankle.
2.  RIGHT LOWER EXTREMITY ANGIOGRAM:  No critical disease in the right common iliac, external iliac and common femoral artery.  The distal superficail femoral artery is occulded in the lower 1/3 of the thigh.  It forms collaterals at the upper 1/3 of the calf.  There is two-vessel flow down to the ankle.

RESULTS OF ANGIPLASTY AND STENTING OF THE RIGHT CORONARY ARTERY:

EQUIPMENT USED:
1. 6-French JR4 guider.
2. Cougar wire.
3. 2.75x12 PROMUS TAXUS drug-eluting stent.

DRUGS USED:
1.  Heparin 4,000 units.
2.  Integrilin double bolus and infusion.

INTERVENTIONAL PROCEDURE IN DETAIL:
After informed consent, we cannulated the right coronary artery with a JR4 guider and crossed the lesion with a Cougar wire.  We placed a 2.75 stent and dilated it up to 11 atmospheres and noticed no residual stenosis or dissection.

Thanks for your help.


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## theresa.dix@tennova.com (Oct 7, 2010)

In my opinion this is not enough to support some of these codes. IT is enough to support the left heart cath and the stent.


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## ladonnaalexis (Oct 7, 2010)

Thank you. Do you think more detail for each procedure needs to be added?


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## sbicknell (Oct 7, 2010)

I am a firm believer in strong detailed documentation. I want the report to show what he did, how he did it and what he found out. This report does not do that. 

I recently worked for a place that it was decided "if they state the results then they must have done the procedure". I laughed and left


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