# Right heart cath



## amym (Jun 10, 2014)

Would it be appropriate to code this as 93451-26, 36556 and not sure if I can bill for the temporary dialysis catheter, not sure of the code?  

PROCEDURES PERFORMED: 

--  Right heart catheterization. 
--  Temporary Dialysis Catheter Insertion. 
--  QR-Hemostasis with Manual Pressure. 
--  Central Line Catheter Insertion. 


HEMODYNAMICS: Hemodynamic assessment demonstrates moderately depressed 
cardiac output, moderately to markedly elevated pulmonary capillary wedge 
pressure, and moderately elevated pulmonary vascular resistance. There is 
moderate biventricular failure. 

PROCEDURE: The risks and alternatives of the procedures and conscious 
sedation were explained to the patient and informed consent was obtained. 
The patient was brought to the cath lab and placed on the table. The 
planned puncture sites were prepped and draped in the usual sterile 
fashion. 

--  Right internal jugular vein access. The vessel was accessed, a wire 
was threaded into the vessel, and a was advanced over the wire into the 
vessel. 

--  Right femoral vein access. The puncture site was infiltrated with 
local anesthetic. The vessel was accessed using the modified Seldinger 
technique, a wire was threaded into the vessel, and a sheath was advanced 
over the wire into the vessel. 

--  Right heart catheterization. A catheter was advanced to the pulmonary 
artery wedge position. 

--  Temporary Dialysis Catheter Insertion..The right femoral venous sheath 
was replaced over a guidewire with a 19 cm Vascath using sterile 
technique. The Vascath was secured to the skin using 3-0 Prolene suture 
and a sterile dressing. 

--  QR-Hemostasis with Manual Pressure.. 

--  Central Line Catheter Insertion..Right internal jugular central venous 
catheter was placed using modified Seldinger technique in the right 
internal jugular vein under fluoroscopic guidance. Catheter was secured to 
the skin using 0 Silk suture and a sterile dressing. 

COMPLICATIONS: 
There were no adverse outcomes. 
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING: 
Test started at 13:49. Test concluded at 14:53. RADIATION EXPOSURE: 
Fluoroscopy time: 8.8 min. 
MEDICATIONS GIVEN: 
Existing Diprovan, infusion rate of 45 mcg/min, IV, at 13:37. 
Existing Dopamine Drip, infusion rate of 10 mcg/kg/min, IV, at 13:38. 
Lasix (Furosemide), 40 mg, IV, at 14:12. 
1% Lidocaine, 4 ml, subcutaneously, at 14:18. 

STUDY DIAGRAM 

HEMODYNAMIC TABLES 

Pressures:  Baseline 
Pressures:  - HR: 116 
Pressures:  - Rhythm: 
Pressures:  -- Pulmonary Artery (S/D/M): 58/32/43 
Pressures:  -- Pulmonary Capillary Wedge: 32/37/30 
Pressures:  -- Right Atrium (a/v/M): 22/22/19 
Pressures:  -- Right Ventricle (s/edp): 53/20/-- 

O2 Sats:  Baseline 
O2 Sats:  - HR: 116 
O2 Sats:  - Rhythm: 
O2 Sats:  -- AO: 10/87/11.83 
O2 Sats:  -- Pa: 10/41/5.66 
O2 Sats:  -- RA: 10/43/5.93 

Outputs:  Baseline 
Outputs:  -- CALCULATIONS: Age in years: 79.61 
Outputs:  -- CALCULATIONS: Average Partial Oxygen - MV: 28.00 
Outputs:  -- CALCULATIONS: Average Partial Oxygen - PA: 27.00 
Outputs:  -- CALCULATIONS: Body Surface Area: 2.09 
Outputs:  -- CALCULATIONS: Height in cm: 175.00 
Outputs:  -- CALCULATIONS: Sex: Male 
Outputs:  -- CALCULATIONS: Weight in kg: 93.90 
Outputs:  -- OUTPUTS: Blood Oxygen Difference: 5.90 
Outputs:  -- OUTPUTS: CO by Fick: 4.67 
Outputs:  -- OUTPUTS: Fick cardiac index: 2.23 
Outputs:  -- OUTPUTS: Fick HR: 116.00 
Outputs:  -- OUTPUTS: O2 consumption: 275.67 
Outputs:  -- OUTPUTS: Vo2 Indexed: 131.66 
Outputs:  -- RESISTANCES: Pulmonary vascular index (dsc): 487.81 
Outputs:  -- RESISTANCES: Pulmonary vascular index (Wood Units): 6.10 
Outputs:  -- RESISTANCES: Pulmonary vascular resistance (dsc): 232.97 
Outputs:  -- RESISTANCES: Pulmonary vascular resistance (Wood Units): 2.91 
Outputs:  -- RESISTANCES: Right ventricular stroke work: 12.35 
Outputs:  -- RESISTANCES: Right ventricular stroke work index: 5.90 
Outputs:  -- RESISTANCES: Total pulmonary index (dsc): 1613.52 
Outputs:  -- RESISTANCES: Total pulmonary index (Wood Units): 20.17 
Outputs:  -- RESISTANCES: Total pulmonary resistance (dsc): 770.59 
Outputs:  -- RESISTANCES: Total pulmonary resistance (Wood Units): 9.63 
Outputs:  -- SHUNTS: Pulmonary flow: 4.46 
Outputs:  -- SHUNTS: Qp Indexed: 2.13 
Outputs:  -- SHUNTS: Qs Indexed: 2.23


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## dblakema@svmh.com (Jun 10, 2014)

It appears to me that 93451 is appropriate for RHC...The insertion of the central line is seperate with 36556 as you have stated because the insertion of the swan ganz catheter appears as if it was done via the femoral vein approach.  The temporary dialysis catheter insertion would be seperate also because it is not included in the CPT for the RHC or central line insertion.

Thank you,
Dorothy
CCS, CCS-P, CCC


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## amym (Jun 12, 2014)

What is the CPT code for the temp dialysis catheter insertion?


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