# Left heart cath w/ left ventriculogram



## cardiology101 (Jun 24, 2011)

Very new to cardiology billing and would sincerely appreciate someones help with this report.  I am going to try to code so help would be greatly appreciated.

PROCEDURE:  LEFT HEART CATH W/LEFT VENTRICULOGRAM

DESCRIPTION:  Groins prepped, right groin injected w/o complications.  Using seldinger technique, 6 french sheath placed in right common femoral artery w/o complications.  All exchanges were done over a wire.  Judkins right and left catheters were then used to engage respective coronary ostia.  The jl5 catheter was used to engage the left coronary ostia.  Angiograms were performed multiple views.  Following this over a wire, a pigtail was placed in the aorta and the aortic valve was crossed.  Left ventriculgram and left ventricular end diastolic pressures were measured, pressures across aortic valve were measured.  On retrograde pullback, there was no gradient noted across the aortic valve.  Ending procedure, groin sheath was removed and manuel compression applied.

FINDINGS:  

HEMODYNAMICS:  The aortic pressure ranged from 112/60 to 121/63.  Heart rate of 50
The left ventricular end diastolic pressure was 17 to 20 mm of mercury.  No gradient across the aortic valve.

CORONARY ANATOMY:  Left main large in caliber.  It trifurcates into a left anterior descending artery, circulflex and a ramus.

LEFT ANTERIOR DESCENDING:  Runs all the way down to the apex, gives a small size first diagonal and a moderate size second diagonal.  There are mild luminal irregularities noted in the proximal left anterior descending.  The mid to distal left anterior descending artery is diffusely diseased 40-50% and of small caliber.  The ramus is small to moderate size branch with mild lumiunal irregularities.

CIRCUMFLEX ARTERY:  The circumflex is dominant, gives off a small obtuse marginal 1 and a moderate to large obtuse marginal 2.  The obtuse marginal 3 has diffuse 40-50% disease and is small caliber.

RIGHT CORONARY ARTERY:  The right coronary artery is non dominant w/mild luminal irregularities.

LEFT VENTRICULOGRAM:  This demonstrated an ejection fraction of 60-65% with tortuosity of the area.

Would I code 93452 Heart Cath and 93463?  
And could you explain why or why not?
Thanks again


----------



## Jim Pawloski (Jun 24, 2011)

cardiology101 said:


> Very new to cardiology billing and would sincerely appreciate someones help with this report.  I am going to try to code so help would be greatly appreciated.
> 
> PROCEDURE:  LEFT HEART CATH W/LEFT VENTRICULOGRAM
> 
> ...



This is easy.  93452 is left heart catheterization W/O CORONARY ANGIOGRAPHY.  93463 is for congential hearts only!  DO NOT UNBUNDLE!  This report is 93458 Coronaries w/ left heart catheterization.
Hope that helps you know the difference,
Jim Pawloski, R.T. (R)(CV), CIRCC


----------



## cardiology101 (Jun 28, 2011)

*L hrt cath w/left ventriculogram*

Sorry, I dont understand.  Can you point out the description that tells me this in 93458? 
Thanks again.
CARDIOLOGY 101


----------



## dadhich.girish (Jun 28, 2011)

I agree with 93458.  The reason is there is angiography performed of all three coronaries, so we are supposed to take code from coronary angiography series.  Even if one coronary artery was examined, still go ahead with this series only.

I hope this has solved your query.


----------

