# Can i bill 93456 & 93458 together



## OPENSHAW (Mar 20, 2013)

Our doctor did the following:

1.)  right heart catheterization
2.)  selective coronary angiography
3.)  aortic root angiography
4.)  closure of the right common femoral artery using a #6 french angio-  seal device

5.)  a lhc was attempted multiple times but unsuccessful.

The patient was on the schedule for a rt and lhc and has severe aortic stenosis.  I have attached part of the op report for your review regarding the lhc that was attempted.

The part regarding the lhc in the op report reads as follows:
Thereafter, we performed selective coronary angiography using a jl4 catheter and a jr4 catheter, which demonstrated no occlusive coronary artery disease.  Thereafter, we attempted to perform a left heart catheterization initially using a multipurpose catheter followed by a feldman catheter.  Multiple attempts to do it under multiple fluoroscopic views were not successful and we abandoned that in favor of obtaining further noninvasive imaging namely possibly a transesophageal echocardiogram to assess the valve area by telemetry.  At this time we performed an aortic root angiography that demonstrated mild aortic insufficiency.  The diagnosis is 424.1

should i code this as 93456-26, 93458-26-53, 93567. I know that code 93458 bundles to code 93456.  The diagnosis is the same which means that code 93458 will prob not get paid.
Or 
93460-26-53, 93567
i do not code for cpt code 75710 since this code bundles.

AFTER READING THE MODIFIERS I AM NOW THINKING 93460-26-52, 75710.
Thank you!


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## Jim Pawloski (Mar 20, 2013)

OPENSHAW said:


> Our doctor did the following:
> 
> 1.)  right heart catheterization
> 2.)  selective coronary angiography
> ...



Try 93456 for coronary angio and right heart cath.
Thanks,
Jim Pawloski, CIRCC


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## theresa.dix@tennova.com (Mar 21, 2013)

OPENSHAW said:


> Our doctor did the following:
> 
> 1.)  right heart catheterization
> 2.)  selective coronary angiography
> ...



I agree with Jim. 93456-26 93567 for aortic root injection with the valve dx.


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## OPENSHAW (Mar 21, 2013)

*93456 & 93458*

If this is the case should i bill 93456-26-22, what about all the time spent in trying to do a lhc, the dr went in to do a rhc and lhc.  Multiple attempts were done reg. the lhc.  So we only can bill for the rhc only?  What if the dr. puts in the op report how much extra time was spent in trying to do a lhc?

I UNDERSTAND BILLING THE 93456-26, 93567

IS THERE ANYTHING TO BILL IN ADDITION TO REG THE ATTEMPTED LHC, OUR DR. SAID HE TRIED NUMEROUS TIMES AND WAS NOT SUCCESSFUL.

THANKS!


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## jewlz0879 (Mar 25, 2013)

Personally, I would go with 93456-26. I would not select 93460 because the catheter never crossed the aortic valve, or doesn't appear to by this portion of the report so I don't agree with 52. I'd love to hear other perspectives. 

It's a shame your physician didn't document more specifically how long these multiple attempts took him; if he had I would use that as my bargaining chip for 22. You may be able to get by with "a LHC was attempted multiple times but unsuccessful," but I think you'll need a little more. How much extra time in addition to the normal procedure time? Or how much additional time in one area? Was there a technical challange, if so what?


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