# Left Herat Cath with Ventriculography .



## jonyleo20 (Feb 27, 2012)

Hi 
I have been running into some OR from Dr's at the Hospital and they are reporting CPT 93458 "Coronary Angiography with left heart Catherization including intraprocedural injection(s) for left ventriculograpy, when performed. 

Now , here is what they are reporting on the OR :

HISTORY OF PRESENT ILLNESS:
Mr. X is a 45-year-old gentleman with history of dyslipidemia
and came to the hospital with atypical chest pain, but had elevation
of troponin to around 0.4.  His EKG shows Q-waves in the
anterolateral wall and also possible delta wave.  Because of risk
factors and EKG and change, after discussion of risks, benefits, and
alternatives, Mr. X agreed to have left heart catheterization
and possible PCI.

The patient was brought into the Cath Lab and under sterile
technique, both right wrist and right groin were prepared.
Diagnostic catheter was done through the wrist with  5-French sheath  placed in the right radial
with administration of 2,000 units of heparin, 2.5 mg of Verapamil,
and 200 mcg of Nitroglycerin.  JR4 catheter was guided towards the
descending aorta with wholey  wire and without problems, 


The right coronary artery that showed multiple irregularities and 80%
lesion in the right posterior descending artery.  The JR cath was
exchanged over the wire for JL 3.5 catheter that engaged the left
main that originated at its usual place in the left coronary cusp.
The left main showed luminal irregularities.  


LAD showed 95% calcified and complex lesion in its mid-portion involving  the bifurcation of the large second
diagonal.  The second diagonal had a 90% ostial and proximal stenosis and arose at a > 90% angle with the LAD.  
The first diagonal was free of disease.  


The left circumflex artery showed 70% mid-portion stenosis.  


The JL 3.5 catheter was changed over to pigtail that was advanced to the left
ventricle and showed LVEDP of 7 mmHg and with injection and EF of 60%
without obvious wall motion or abnormalities.  The right wrist sheath
was removed and a radial wrist  band was placed.


This last part never talks about a Ventriculography been performed right ???? Maybe they are considering LVEDP measurments as a Ventriculography ??? please advice if the following CPT are correct to use 

CPT:

93454,26
93799 ( for the LVEDP measurments ) 

THX ..


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## Jess1125 (Feb 27, 2012)

jonyleo20 said:


> Hi
> I have been running into some OR from Dr's at the Hospital and they are reporting CPT 93458 "Coronary Angiography with left heart Catherization including intraprocedural injection(s) for left ventriculograpy, when performed.
> 
> Now , here is what they are reporting on the OR :
> ...



You do have a 93458 here. With the new cath codes in 2011 the left ventriculography isn't a requirement. If you look at the description it says left ventriculography "when performed". Will report 93458 whether ventriculography was done or not. 

Jessica CPC, CCC


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## jonyleo20 (Feb 28, 2012)

Good Morning Jessica .

Wishing you a nice day and just wanted to Thanks you for your help .... I was getting confuse about the LVEDP . 

I really appreciate it ... Thx


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