# Procedure Billing



## peeya (Mar 29, 2012)

Guys I need help in billing this procedure. Can someone please help.

PROCEDURES
1. Left heart catheterization and angiography.
2. Bilateral selective angiography.
3. Left ventriculography.
PROCEDURE NOTE: Informed consent was obtained from the patient. The
patient was premedicated and brought to the catheterization lab. He
was sterilely prepped and draped and locally anesthetized. The right
femoral artery was cannulated using the Seldinger technique and a 6-
French sheath was inserted. Thereafter, over a J-wire, a 6-French JL4
catheter was advanced to the left coronary artery. Selective
angiography was performed. This was withdrawn and a JR4 catheter was
advanced over the wire. Selective angiography was performed. This was
exchanged for a 6-French JL4 guiding catheter and advanced to the
right coronary artery. A Whisper was advanced distally into the
distal RCA and a 2.5 x 12 mm balloon was advanced to the lesion site.
PTCA was performed up to 14 atmospheres. This was withdrawn,
exchanged for a 3.5 x 20 mm balloon and inflated up to 6 atmospheres
at less than 3.4 cm with 70% residual stenosis and now there is TIMI-
3 flow. The chest pain had almost resolved. The procedure was
tolerated without complications.
Thereafter, a pigtail catheter was advanced into the left ventricle.
Left ventricular pressures were obtained. Left ventriculogram was
performed. The patient tolerated the procedure without complications
and the sheath was sutured in place.
LEFT VENTRICULOGRAPHY: Left ventriculography was performed in the RAO
position with 30 mL of contrast. The left ventricular function is
moderately depressed with ejection fraction 40% to 45%, with inferior
wall hypokinesis. There is no evidence of an AV gradient. Left
ventricular pressure is 138/7/24 mmHg. Post-ventriculogram is
142/7/23 mmHg

*I would bill this with 93458 correct..*

But then this happened.

PROCEDURE NOTE: Informed consent was already obtained. The patient was on the Cath table.  The right JR4 catheter was advanced to the right coronary artery.  It was completely occluded.  A Whisper wire was advanced distally in the right coronary artery. PTCA with a 3.5 by 20-mm balloon was performed. This was exchanged for a 4.0 x 20-mm stent. It was a bare metal stent.  It was too long. This was exchanged for a 4.0 x 20-mm bare metal stent deployed at 14 atmospheres (4.4 mm) with 0% residual stenosis and TIMI-3 flow. ST elevations had resolved. The patient is almost chest pain free.

An intraaortic balloon pump was not placed and the patient was hemodynamically stable. Chest pain was markedly better. ST's had come down.

*So what do I bill now..??*


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## theresa.dix@tennova.com (Mar 30, 2012)

peeya said:


> Guys I need help in billing this procedure. Can someone please help.
> 
> PROCEDURES
> 1. Left heart catheterization and angiography.
> ...



Peeya,
 So if Im reading this right(its early in the morning not totally awake yet, drinking coffee) you have a lhc and ptca for the first part of this report.  And then they eventually placed a stent in the distal part of the RC. SO it looks to me you have 93458-26-59 and 92980 RC.


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## dpeoples (Mar 30, 2012)

peeya said:


> Guys I need help in billing this procedure. Can someone please help.
> 
> PROCEDURES
> 1. Left heart catheterization and angiography.
> ...



I agree with Theresa. It looks like the same operative session so the ptca is included with the stent placement.
92980 RC
93458-26,59

HTH


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## peeya (Mar 30, 2012)

So should I bill this with modifier 22 ?

92980 RC 22
93458 26 59


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## jewlz0879 (Mar 30, 2012)

I don't think it warrants a 22. I don't see that he had to spend an extensive amt of time on this case or placing the stent or he didn't document as such, sure, the RC was completely occluded, however, the patient was hemodynamically stable.


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## 634sg4fs65g4fg (Mar 30, 2012)

-59 on the 93458-26


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