# LHC & Stent



## nancy.anselmo@ccrheart.com (Sep 20, 2011)

We have been getting denials for the LHC when done w/Stent and our Doc wants me to put a modifier 57 on the cath is this something I should do? 

Indication : Angina pectoris, CAD
HPI: pt 71, extensive CAD, status post multible percutaneous interventions in the past w/multible stents to his proximal LC as recent as June 2008 as well as stents to his RCA in the past. He presents complaining of intermittent angina. He does have a known chronically occulded LAD that is fed by right-to-left collaterals. He has been maximized on medical therapy as tolerated. He has had persistant symptoms and therefore was referred for diagnostic angiography with an eye to percutaneous intervention as indicated.

Procedure:   Right common femoral artery was accessed using modified Seldinger technique of which a 6 French 11 cm sheath was placed without complication. Diagnostic JL4 and a 3DRC cath was used to perform SCA and LHC. At the conclusion of the procedure, iliac angio was performed that demonstrated insertion of the arteriotomy site just superior to the bifurcation and therefore manual compression was elected for hemostasis.

Hemodynamics: Left ventricular end-diastolic pressure measured 10mmHg. There was no transaortic gradient upon pullback.

SCA
Left main: Mild disease

LAD: Totally occulded in it's proximal portion. There was evidence of a subtotal contrast distrobution in it's proximal segment and eventually was totally occluded. The remaining aspect of the vessel was seen being filled fromcollaterals to the RCA which were extensive and filled a portion of the LAD printed backup into the proximal segment.

LC: Modest disease. There was a patent stent seen in the proximal portion. There was a prominent, guite tortus first marginal branch of which multiple projections were required to identify an ostial stenosis.

RCA: Mild disease. It was a large caliber vessel extending to the apex and a large PL branch. There was apatent stent seen at it's ostium. This is seen in multiple projections and there did not appear to be any ostial stenosis.

Summary: Significant CAD w/a total chronic occlusion of the left anterior descending artery and ostial stenosis of a first obtuse marginal.
In light of the pt's symtoms and evidence of de novo lesion in the circumflex distribution as well as chronic total occlusion an attemt at revascularization was decided upon.


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## Jess1125 (Sep 20, 2011)

n.anselmo@yahoo.com said:


> We have been getting denials for the LHC when done w/Stent and our Doc wants me to put a modifier 57 on the cath is this something I should do?
> 
> Indication : Angina pectoris, CAD
> HPI: pt 71, extensive CAD, status post multible percutaneous interventions in the past w/multible stents to his proximal LC as recent as June 2008 as well as stents to his RCA in the past. He presents complaining of intermittent angina. He does have a known chronically occulded LAD that is fed by right-to-left collaterals. He has been maximized on medical therapy as tolerated. He has had persistant symptoms and therefore was referred for diagnostic angiography with an eye to percutaneous intervention as indicated.
> ...



Did you mean a -59 modifier? CCI edits bundle the cardiac cath into the intervention codes but if it is truly a diagnostic study then a -59 modifier is appropriate to put on the cath. In reviewing your case above, it appears to be a diagnostic study to me as patient was having persistent angina and I would bill the left heart cath with a 59 modifier with the intervention that I assume was done here. Doesn't appear that portion of report was posted. 

Jessica CPC, CCC


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## dimmitta (Sep 21, 2011)

I agree with Jess, this looks like it was diagnostic heart cath and should be unbundled from intervention with a 59 modifier.


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