# LHC w/aortogram and peripheral  angiography



## aparscal (Apr 6, 2015)

Can someone help me code the Aortogram. It is separately billable from the LHC,correct?  
93458.26 and
75630.26(59), or 93567? 

PROCEDURES PERFORMED:
1. Left heart catheterization.
2. Coronary angiography.
3. Left ventriculogram.
4. Left internal mammary artery angiography.
5. Aortogram and peripheral runoff angiography.
INDICATION:  The patient is a  man who has significant peripheral
arterial disease with a history of previous bilateral iliac stents and left
femoral artery stent who has severe diffuse left lower extremity.  He was
preop for vascular surgery, but a stress test preoperatively was abnormal.
He was referred for diagnostic angiogram to rule out obstructive coronary
disease.
DESCRIPTION OF PROCEDURE:  After informed consent was obtained, he was
brought to the cardiac cath lab, where he was prepped and draped in sterile
fashion.  Lidocaine 2% was used to anesthetize the right radial artery
region.  Please note, Allen's test was normal prior to procedure.  A Terumo
Glidesheath, PA was advanced after which a peak catheter was advanced
through the aortic root and engaged in the left coronary artery.  After
that, angiography of the right coronary artery was performed.  After that,
the catheter was withdrawn to the aortic arch and angiography of the left
subclavian artery and left internal mammary artery was performed.  Catheter
was exchanged for 6-French pigtail catheter, which was then advanced to the
left ventricle.  Single planer left ventriculogram was performed.  Catheter
was then removed.  A TR band was then applied.  The patient was sent to the
cardiac support unit for admission due to evidence of severe ostial left
main disease and total occlusion of the right coronary artery, and the
patient is awaiting for bypass.
RESULTS:  Hemodynamics:  Left ventricular pressure 145/4, end-diastolic
pressure of 18.
Coronary angiography:
1. Left main coronary artery:  A 2 mm vessel that has an ostial stenosis
    of 60% to 70% stenosis.  It bifurcates in the usual manner without
    anomaly.
2. Left anterior descending artery:  A small caliber 1.5 mm vessel with
    mild diffuse disease.  No significant obstruction.
3. Left circumflex artery:  A 2 mm vessel.  In some views at the mid
    portion, there is a 70% to 80% stenosis.  The first obtuse marginal
    artery is a 2 mm vessel that is normal.  There is evidence of grade 2
    left-to-right collateralization.
4. Right coronary artery:  A diminutive right coronary artery with chronic
    total occlusion of a long segment of its midportion.  The distal
    portion gives rise to a small caliber PDA, which may be small in
    caliber, due to chronic total occlusion.  There is evidence of
    collateral flow from the left.
5. Left internal mammary artery:  This is an anastomosed vessel, 2 mm and
    is normal, and suitable for use in bypass grafting.
6. Left ventriculogram:  Normal left ventricular size and systolic
    function.  Ejection fraction of 65%.  No mitral regurgitation.  No
    transaortic valve pressure gradient.  Aortogram was also performed that
    showed bilateral iliac stent that is patent and left femoral artery
    stent that is occluded.
SUMMARY:
1. High-grade ostial left main stenosis with chronic total occlusion of
    the right coronary artery, receiving left-to-right collateralization.
2. Adequate bypass graft target.
3. Left internal mammary artery suitable for use in bypass grafting.
4. Normal left ventricular systolic function.
5. No mitral regurgitation.
6. No aortic stenosis.
7. Peripheral arterial disease.

thanks!


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## ccollison (Apr 23, 2015)

My choices would be:
 cath 93458
 internal mammary  75756
 left subclavian catheter placement 36215
 aortogram with run off 75630 (above aorto-iliac level)

C Collison CPPM, CCC


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## shescka (Apr 30, 2015)

I will code it 93459, 26 with 75630, 26,59


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## Chlrtrep (Apr 30, 2015)

I agree with 93459   as it is has been noted to use  this code for the  injection into the LIMA for bypass viability during a cath.

However I have concerns with the abdominal aortagram  as there is no mention of catheter placement in the aorta around the area of the renals, and there is no mention in the physicians findings regarding the abdominal aorta, the renals, mesenteric or celiac vessels generally associated with an abdominal aortagram.

75630 appears to be what the physician implies was done. However I do not feel documentation supports it.  Based on what is in the report this is more like 93459, G0278


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