# Right/left Heart cath w/root



## sslater (Jun 28, 2011)

I am making sure i haven't missed anything in the following cath report..  i have 93460-26 and 93567.  Are there any other add on codes for the pressures, cardiac output and thermodilution that i'm missing or are they included in the cath codes already?  
Thanks.. i don't get the R/L Caths a lot so i just wanted to double check!!  


PROCEDURE: Left and right heart catheterization with selective
coronary arteriography, left ventriculography, distal aortic root
shot.

  A.  DYE USED:  Less than 100 cc's of dye.
  B.  COMPLICATIONS: No acute or apparent complications.
  C.  PREMEDICATIONS:  25mg of p.o. Benadryl and 5mg of p.o.
      Valium.
  D.  TECHNIQUE: Modified Seldinger technique through the right
      femoral artery and right femoral vein.
  E.  CATHETERS:  5 French sheath in right femoral artery, 7
      French sheath in the right femoral vein with 7 French Swan-
      Ganz catheter. JL4 and JR4 were noted and 5 French pigtail
      were used.

PRESSURES/SATURATIONS: IVC saturation was 78. SVG 65, PA 70, high
RA 71.8, RV 69.5. AO 99%.  No apparent shunting was identified on
the right side.

Cardiac output and index using thermodilution were 4.5 and 2.6.

Pressures were noted.  Aortic pressure was 130/80. LV  was
129/17. EDP was normal.  No apparent aortic valve gradient was
noted.  RA mean pressure was 4.  RV was 20/4.  PA pressure was
about 20/10.  Right sided pressures were relatively within normal
limits.

ANGIOGRAMS:

  A.  LEFT MAIN:  Left main coronary artery had a normal
      arteriogram.

  B.  LEFT ANTERIOR DESCENDING: The LAD had a 20-30%
      irregularities throughout its course.  Some calicification.
       First diagonal was a moderate calibered vessel and had a normal arteriogram.
  C.  CIRCUMFLEX:  The circumflex artery was a moderate calibered
      vessel artery. It gave rise to an OM1, which was moderate
      and had 20-30% irregularities.  OM2 was moderate and had 20-
      30% irregularities.
  D.  RAMUS INTERMEDIUS BRANCH: Ramus intermedius branch was a
      moderate calibered vessel artery. It had 20-30%
      irregularities.
  E.  RIGHT CORONARY ARTERY:   RCA was dominant. It had 20%
      irregularities. PDA was a moderate calibered vessel artery
      and had a normal arteriogram. PL branch was a moderate
      calibered vessel artery and had a normal arteriogram.

LEFT VENTRICULAR: LV was visualized in RAO projection. EF was
estimated at 60%.  Plus 1 MR was noted. Volumes were within
normal limits.

DISTAL AORTIC ROOT SHOT: Distal aortic root looked at the renal
arteries non-selectively, which did not have any significant
disease. 20-30% irregularities were noted in the left renal
artery.

IMPRESSION:
  1.  Right-sided pressures were normal.  No apparent shunting
      was noted on the right side. Cardiac output index was
      normal. LVEF was normal. Plus 1 MR is noted.  Coronaries
      had 20-30% irregularities in the left system and right
      system.
  2.  Renals did not have any significant disease


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## dpeoples (Jun 28, 2011)

sslater said:


> I am making sure i haven't missed anything in the following cath report..  i have 93460-26 and 93567.  Are there any other add on codes for the pressures, cardiac output and thermodilution that i'm missing or are they included in the cath codes already?
> Thanks.. i don't get the R/L Caths a lot so i just wanted to double check!!
> 
> 
> ...





Pressures and output are included in the heart cath code (93460), however, 93567 does not apply in this case. The aortic "root" is the portion of the aorta that connects to the heart, not the distal area above the bifurcation. For non-selected renals you should code G0275 or 75625 depending on payor.

For future reference, 93567 supravalvular aortography, is an add on code for evaluation of the area of the aorta extending (ascending) from the heart to the arch.

HTH


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## bailsb (Jul 10, 2011)

*CIRC cert*

Hi Danny,

I noticed in a previous post a poster had asked you about the CIRC certification and how much time you spent studying etc.  I am an inpatient physician coder and have been coding for about 2 years now.  I am starting to see more and more cardiac/circ charts as my company assigns me to different facilities.  If it's not too much trouble, could you tell me how you went about preparing for the exam and how intense the exam is.  Is there one prep course you recommend?  My personal email is bailsb@hotmail.com.

I really appreciate your help,
Brendan, CPC


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## dpeoples (Jul 12, 2011)

bailsb said:


> Hi Danny,
> 
> I noticed in a previous post a poster had asked you about the CIRC certification and how much time you spent studying etc.  I am an inpatient physician coder and have been coding for about 2 years now.  I am starting to see more and more cardiac/circ charts as my company assigns me to different facilities.  If it's not too much trouble, could you tell me how you went about preparing for the exam and how intense the exam is.  Is there one prep course you recommend?  My personal email is bailsb@hotmail.com.
> 
> ...



Brendan, check your private messages on this forum, let me know if that doesn't work.
dp


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