# Cardiac Caths help!



## beatjones (Jun 10, 2009)

What code would I use to capture an angiogram performed in the innominate vein during a hearth cath. Also when an injection (in any angiographic procedure) is performed by hand is  there any "extra" coding involved? 

thanks in advance for your help


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## whitesidedolphin (Jun 10, 2009)

The innominate vein is the same as the brachiocephalic.  Use 36010 if your physician selectively engaged this vein.  The venography is coded using 75820 if only one side was imaged.  A bilateral venography would use a 75822.  I hope that helps.  

I am double checking the second part of your question.


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## dpeoples (Jun 10, 2009)

beatjones said:


> What code would I use to capture an angiogram performed in the innominate vein during a hearth cath. Also when an injection (in any angiographic procedure) is performed by hand is  there any "extra" coding involved?
> 
> thanks in advance for your help




It all depends on the access point but possible codes are:
36005 (if direct access)
36011 (if separate from access for heart  cath and access is femoral/iliac)
36010 should not be charged as that is for the selection of the vena cava.

or no cath code if the same access is used for the heart cath (36005/36001 is included with 93501 etc)

the imaging and inpretation code would be 75820.

However, if the above mentioned procedure is performed just to evaluate an access site or for mapping purposes, it should probably not be charged.

I hope this helps.


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## beatjones (Jun 10, 2009)

Ok, let me make sure I understand this correctly. If an angiogram is done in the innominate vein (or superior vena cava etc.) it's bundled with the heart cath unless it's it's direct access? In my mind I'm thinking there are seperate codes for injection of pulmonary, lt/rt ventricles/atrium etc. but not for an injection for angiogram for the innominate vein (or superior vena cava)? Thanks again, I'm just trying to clarify my understanding about this...Here's a sampling of the documentation:

Angiograms were performed in the superior vena
cava, right ventricle and distal transverse aortic arch... and further in the documentation it's noted:

Hand injection in the innominate vein demonstrates
normal systemic venous return to a single right-sided superior
vena cava.

You all are the greatest...thanks again for your help


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## dpeoples (Jun 11, 2009)

beatjones said:


> Ok, let me make sure I understand this correctly. If an angiogram is done in the innominate vein (or superior vena cava etc.) it's bundled with the heart cath unless it's it's direct access? In my mind I'm thinking there are seperate codes for injection of pulmonary, lt/rt ventricles/atrium etc. but not for an injection for angiogram for the innominate vein (or superior vena cava)? Thanks again, I'm just trying to clarify my understanding about this...Here's a sampling of the documentation:
> 
> Angiograms were performed in the superior vena
> cava, right ventricle and distal transverse aortic arch... and further in the documentation it's noted:
> ...





Yes, there are separate codes for the injection of the pulmonary arteries, ventricles etc. Whether or not to charge for an innominate/extremity venography depends on the answer to this question:

*Would the phyician have performed this (injection of the innominate and images) procedure if he was not performing a heart cath?*

If the answer is yes (this would imply a separate access), then you should code accordingly and modify with a 59.

If the answer is no, then it is just part of the heart cath and should not be separately reported. IMO

Also, injection by hand has no bearing on the code selection.

I hope this helps.


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## beatjones (Jun 11, 2009)

Yes,that helped...

Now it makes sense. Thanks so much!


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