# Cath/angio/stents....



## maryann1224@bellsouth.net (Nov 7, 2013)

ARE THE CHOICES OF THESE CODES CORRECT?

93459 26 59
92928 RC
92937 LD 59
36140 (59)

Left heart catheterization.
. Left ventriculogram.
. Coronary angiography.
. Saphenous vein angiography.
. Internal mammary angiography.
. Additional arterial access angioplasty and stenting of the
right coronary artery.
. Angioplasty and stenting of the left anterior descending
artery through the mammary graft.

INTERVENTION:
Based on findings at diagnostic catheterization we
proceeded with intervention on the right coronary artery. Angiomax
was administered and the right coronary was engaged with a MAC 3.0
guide catheter. I then advanced a Whisper wire into the posterior
descending artery and then tried to advance a 1.5 balloon;
however, after multiple attempts with several different balloons,
we were unable to cross the lesion. This was due to very poor
backup support from the #5 French guide. At this time, the
decision was made to change access site to the groin and I
obtained percutaneous access in the right common femoral artery. I
placed a #6 French sheath and then engaged the right coronary
artery with an XB-RCA #6 French guide catheter. I was able to
rewire the lesion with a run through wire. I was then able to
perform angioplasty with the 1.5 Sprinter balloon throughout the
right coronary artery and then a 2.0 x 20 Trek balloon. I then
tried to advance a 2.5 x 38 Promus Element stent into the right
coronary artery; however, I was unable to cross the proximal to
mid segment of the right coronary artery, again due to poor
backup. I then used a 6-French guide liner and the 2.0 balloon and
advanced the guide liner into the mid right coronary artery and
performed angioplasty through the mid right coronary artery. I was
unable to deliver the 2.5 x 38 mm Promus Element stent and covered
the lesions in the mid to distal right coronary artery. This stent
was deployed at high pressure for 40 seconds. I then returned with
a 2.5 x 12 balloon and angioplastied within the right coronary
stent proximally and in its mid segment up to a maximum of 18
atmospheres. After removal of balloons and wires there was TIMI-3
flow with no perforation, dissection or distal embolization.
Length of the lesions covered was 36 mm.

Attention was then turned to the LAD. I used a 5-French mammary
catheter to engage the left internal mammary artery. I advanced a
run-through wire across the lesion in the apical LAD. I used a 2.0
x 8 mm Trek balloon to dilate the distal LAD and then deployed a
2.25 x 8 mm Promus Element stent in the distal LAD at 9
atmospheres for over 30 seconds. After removal of balloons and
wires there was TIMI-3 flow with no perforation, dissection or
distal embolization. Angiography was performed of the common
femoral artery demonstrating arteriotomy above the bifurcation.
This was successfully sealed with a 6-French Perclose device.
Manual pressure was applied with a TR band to the left radial
access site. 

THANKS FOR ANY ASSISTANCE!


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## Jim Pawloski (Nov 11, 2013)

maryann1224@bellsouth.net said:


> ARE THE CHOICES OF THESE CODES CORRECT?
> 
> 93459 26 59
> 92928 RC
> ...



Hi Maryann,
I reviewed this case, and I agree with your codes except for 36140.  That is bundled into the Perclose device.
Thanks,
Jim Pawloski, CIRCC


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## maryann1224@bellsouth.net (Nov 13, 2013)

thank you Jim! would you not be able to code 36140 59 due to  the dr having to switch access sites and go thru the right common femoral now?  always appreciate your assistance, or is it included with the addt'l stenting code?


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## Jim Pawloski (Nov 13, 2013)

maryann1224@bellsouth.net said:


> thank you Jim! would you not be able to code 36140 59 due to  the dr having to switch access sites and go thru the right common femoral now?  always appreciate your assistance, or is it included with the addt'l stenting code?



The report didn't give me the original access site.   I think the heart cath codes would cover the first access if the heart cath was performed from there, and the intervention codes cover catheter placement from the femoral artery.
Thanks,
Jim


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## maryann1224@bellsouth.net (Nov 14, 2013)

thank you Jim for the clarification!


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