# Am I coding this correctly? - had this procedure:



## AshleyMartin (Mar 17, 2011)

Please help me code this:

A 75 year old Female went to the cath lab and had this procedure:

1. Coronary angiography
2. LIMA angiography
3. Saphenous vein graft angiography
4. Temporary venous pacer
5. Aspiration thrombectomy
6. PCI of left circumflex with bare metal stent

I will not post to op note because I have that one coded correctly. But this next one I have questions on.

While being observed in the ICU, she continued to develop tachycardia as well as hypotension requiring significant pressors. She was brought back for re-look angiography plus/minus PCI of the LIMA as well as to verify no active bleeding at the prior arterial access site in the groin. 

Procedure:
1. Triple lumen catheter placement
2. Intra-aortic balloon pump placement
3. Abdominal aortogram
4. PTA of the right common iliac artery.

Procedure in detail:
The patient was emergently brought back into the cath lab. She was prepped and drained in a sterile fashion. We exchanged a 6-French sheath in the right arterial access site for a 2-sheath under sterile technique. Angiography was performed at the right arterial access site showing no active extravasation of blood. The patient upon transfer to the table had also developed a bowel movement that was significantly bloody consistent with lower GI bleed. We then called GI emergently. Dr L came and placed an NG tube which aspirated no significant amount of blood. The patient was started on Protonix. We then exchanged the right venous access for a triple lumen and exchanged the 6-French arterial sheath for balloon pump sheath and placed a balloon pump after angiography was perfomed showing patency of the left main and the left circumflex. The balloon pump had some difficulty going up the iliac. There was a lesion of the right common iliac artery that was verified by abdominal aortogram. We then used a glide wire to pass it. A stiff Amplatz wire was exchanged over this 10x20 ultrathin SDS balloon was used to dilate the lesion. Then we were able to pass a balloon pump in the triple lumen as well as the balloon were sutured to the skin. Again, the patient was stable on pressors upon transfer the the ICU. 

Findings:
1. The is eccentric calcified plaque at the ostium of the right common iliac artery.

Intervention:
1. 80% lesion was reduced to less than 20% by PTA with a 10x20 millimeter ultra-thin SDS balloon.

Diagnosis:
1. Lower GI bleed
2. Patent stent in the left circumflex
3. Acute systolic heart failure status post intra-aortic balloon pump placement. 

This is what I have:
36200
75630-26
33967
35473
75962-26

Do I append modifier 78 to all codes?


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## jewlz0879 (Mar 18, 2011)

The new revascularization codes for LOWER EXTREMITYs include cath placements, S&I (except if it meets requirements to bill; add 59), transversing the lesion, closure of ateriotomy ect. See pg. 208 in CPT. 

That being said, I would bill 37220. 33967 - that's it. Not sure you need the 78 because the heart cath, thrombectomy or temp pm do not have globals. Should be different dx too. Maybe 440.20, if documented.


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