# Right Heart Cath + Venogram SVC



## amym (Aug 19, 2013)

What code would I use to bill the Venogram during right heart cath?  75820-26?

PROCEDURES PERFORMED:
-- Saphenous vein graft angiography.
-- Right Heart Catherization- Nitric Oxide.
RECOMMENDATIONS:
Venogram: no SVC thrombus
Normal right sided pressures

INDICATIONS: Pulomnary HTN
HEMODYNAMICS: Hemodynamic assessment demonstrates normal LVEDP, normal
cardiac output, and normal pulmonary capillary wedge pressure. There is
borderline pulmonary hypertension.
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 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.
-- Saphenous vein graft angiography. A catheter was advanced to the aorta
and positioned at the aortic anastomosis of the graft under fluoroscopic
guidance. Angiography was performed in multiple projections using
hand-injection of contrast.
-- Right Heart Catherization- Nitric Oxide..

MEDICATIONS GIVEN:

CONTRAST GIVEN:
Omnipaque 50 ml.

STUDY DIAGRAM
HEMODYNAMIC TABLES
Pressures: Baseline
Pressures: - HR: 68
Pressures: - Rhythm:
Pressures: -- Pulmonary Artery (S/D/M): 29/12/21
Pressures: -- Pulmonary Capillary Wedge: 8/11/8
Pressures: -- Right Atrium (a/v/M): --/--/511
Pressures: -- Right Ventricle (s/edp): 29/6/--
Outputs: Baseline
Outputs: -- CALCULATIONS: Age in years: 25.80
Outputs: -- CALCULATIONS: Body Surface Area: 1.45
Outputs: -- CALCULATIONS: Height in cm: 152.00
Outputs: -- CALCULATIONS: Sex: Female
Outputs: -- CALCULATIONS: Weight in kg: 50.00


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## dpeoples (Aug 19, 2013)

amym said:


> What code would I use to bill the Venogram during right heart cath?  75820-26?
> 
> PROCEDURES PERFORMED:
> -- Saphenous vein graft angiography.
> ...



This report is missing alot of very important detail, which makes a code assignment difficult.  I will say a venography (extremity or vc) is not appropriate due to lack of an interpretation of the images.

This looks to me to be a RHC with bypass graft evaluation (and coronary arteries). As such I would lean toward 93457, as the only code.

HTH


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## CPCCODERII (Aug 20, 2013)

Because he doesnt state a lot about his procedure, I might have even leaned towards a more conservative level of 93455 because he didnt state he made it to the pulmonary arteries, right atrium, or ventricle.  The findings are there to show that a right heart cath was performed, but this report could use some additonal information.


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## TWinsor (Aug 20, 2013)

I agree with Danny.  The RHC pressures are all listed at the end of the report.


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## CPCCODERII (Aug 20, 2013)

I would go there as well, I would however give some feedback to the provider for future cases as we learned via a training course that unless those areas are mentioned, even with findings, the documentation may not support billing the RHC if documentation was ever requested by insurance.  I feel the documentation of the procedure could have used a little more detailed as to where the catheter was placed.


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