# Help...Cardiac Catheterization



## Goyard71 (Aug 12, 2013)

Hello! I am not sure if I coded this procedure correctly.  I coded it as 93460. But I am not quite too sure if Left cath was performed because it did not mention if the catheter passed through the aortic valve and into the left ventricle.  Please see procedure below...

Thank you for the help!

PreOperative Diagnosis: Cardiogenic  shock and congestive heart failure
Procedure performed: Cardiac  Catherization
Procedure:  The patient was brought to the catheterization lab and prepped and draped in a sterile fashion. Lidocaine was placed to the right common femoral area, and 8 French sheath was placed into the right common femoral vein, and a 6 French sheath was placed into the right common femoral artery using Seldinger technique.
Next, angiography of the common femoral arterial site was performed. Next, right heart catheterization was performed with a PA catheter measuring RA,RV,PA and pulmonary capillary wedge pressures. Simultaneous pulmonary arterial and femoral arterial saturations were used for Fick cardiac output and hermodilution cardiac output was obtained.
Next, left heart catheterization was performed with a JL4 with multi-view angiography followed by a Williams right and agiography of the right system. Next, The Williams right was removed. The PA catheter was sutured into place with the sheath and the protection device and an Angio-seal was placed in the right common femoral artery. The patient remained somewhat hemodynamically stable although in critical condition and respiratory status has remained stable.

Impression:
Right heart catheterization: 
RA pressure of 20. RV 77/20. PA pressure 77/30. Pulmonary capillary wedge pressure of  30. Fick cardiac output of 5 with thermodilution cardiac output of 4.5. SVR of 992 on 10 of Levophed.

Left heart catheterization:
Left main, no disease.  Left anterior descending is widely patent with diagonal branches extending through the apex, which is patent.  Left circumflex, Osteal and proximal segments are patent: however, at the level of a large obtuse marginal there is severe 90+ disease which extends into the obtuse marginal , and the rest of the circumfles appears to have a chronic total occlusion at maximal grade 1 collaterals from the left system.  Right coronary artery, the RCA in its proximal segment is 60%. Distally it has severe,long,diffuse 80% to 90% extending into a posterolateral and PDA branches,which are quite small.


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## dpeoples (Aug 13, 2013)

Goyard71 said:


> Hello! I am not sure if I coded this procedure correctly.  I coded it as 93460. But I am not quite too sure if Left cath was performed because it did not mention if the catheter passed through the aortic valve and into the left ventricle.  Please see procedure below...
> 
> Thank you for the help!
> 
> ...



 You're suspicion is correct. The left heart (atrium/ventricle) was not selected so 93460 is not applicable. I would code this 93456, coronary angios with right heart cath.

HTH


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## Goyard71 (Aug 13, 2013)

dpeoples said:


> You're suspicion is correct. The left heart (atrium/ventricle) was not selected so 93460 is not applicable. I would code this 93456, coronary angios with right heart cath.
> 
> HTH


Thank you very much.


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