# Help coding LHC please



## dgarri (Oct 30, 2010)

I have type the report for anyone willing to assist me in coding this cath.  Here's what I have so far but it just doesn't seem right.

93510-26, 93543, 93556-26-59, 93545-59, 93555-26-59, 93544-59, 75724-26-59, 36245-LT-59, 36245-RT-59, G0278-29-22, I think my problem is with the renals/iliac's coding? Should I be using the 75630-26?

Indications: An 80 yr old female with h/o paroxysmal atrial fibrillation, tobacco abuse, coronary disease, and most recently positive adenosine cardiolite with recent worsening of dyspnea.
Procedure: Under sterile conditions and local anesthesia, a 6-french sheath was insesrted percutaneously in the right femoral artery and the coronaries were visualized  using a 6-french Judkins left 4 and 6-french 3-DRC. The procedure was techinacally difficult due to tortuosity in the iliac system.  There was a 90% stenosis at the origin of the right common iliac artery.  There was also heavy calcification of the right iliac artery.  A long exchange wire and a glidewire had to be used to cross the subtotal occlusion in the right iliac artery.  Next, there was difficulty in advancing the catheters into the coronary sinuses and a long sheath had to be used. 

The left ventriculogran and the abdominal aortogram were done using a 6-french pigtail.  At the end of procedure, a hand injection was done through the side arm of the sheath in the right common femoral artery and hemostasis will be obtained by using manual pressure. 
Summary of Hemodynamics:  The heart rate was 69 beats per minute.  pace rhythm with intermittent sinus rhythm.  The blood pressure was 135/60. Left ventricular pressure was 135/14.
Summary of the Left Ventriculogram: This was done in the RAO projustion.  There was near-normal left ventricular contratcion with possible mild apical hypokinesis.  The overall ejection fraction is around 55%. There was als moderate-to-severe mitral regurgitation with dilated left atrium.
Summary of the Abdomianl Aortogram: An abdominal aortogram was done to assess the renal arteries.  Each kidney had a single renal artery.  Both renal arteries were normal.
Summary of the Distal Aortogram and Iliac Angiograpy: The distal aorta showed multiple irregularities and few z-form appearance.  The origin of the right common iliac artery shoed an eccentric 90% stenosis.  There was heavy calcification in the right common iliac artery.  There were multiple irregularities in the righa nand left common and internal iliac arteries bilaterally.
Summary of the Coronary Arteries: The right coronary artery showed 90% ostial stenosis.  Ther right coronary artery was otherwise normal.  However, there were collaterals from the left system filling the distal right coronary artery because of the dampened pressure due to the ostial RCA lesion.  The right coronary artery was otherwise normal.
The left main was normal.
The LAD showed a corkscrew appearance consistent with hypertensive heart disease.  The LAD and diagonal branches were normal.
The circumflex was a small nondominant vessel.  The circumflex vessel and the obtuse marginal branch were normal.

Summary:
1. Near-normal left ventricular contraction with an ejection fraction around 55%. Mild apical hypokinesis cannot be ruled out.
2. Moderate-to-severe mitral regurgitation with evidence of dilated left atrium.
3. A 90% ostial right coronary artery stenosis with rich collaterals from the left system filling the distal right coronary artery otherwise, normal coronary arteries.  The left coronaries were normal.
4. Evidence of disease in the distal aorta with 90% eccentric stenosis at the origin of the right iliac artery.  The right common iliac artery was heavily calcified.
5. Normal renal arteries.
6. Technically difficult and challenging study.  The study ws time consuming as well.

If the patient develops intractable angina, one migh consider stenting to the ostium of the right coronary angiography; however, this would be a technically challenging procedure.

Thanks
Diana
dgarri@juno.com
I am a student at this time, working on certification while working for a Cardiologist.


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## Jim Pawloski (Oct 30, 2010)

dgarri said:


> I have type the report for anyone willing to assist me in coding this cath.  Here's what I have so far but it just doesn't seem right.
> 
> 93510-26, 93543, 93556-26-59, 93545-59, 93555-26-59, 93544-59, 75724-26-59, 36245-LT-59, 36245-RT-59, G0278-29-22, I think my problem is with the renals/iliac's coding? Should I be using the 75630-26?
> 
> ...



Hi Diana,
You were good, until after the actual heart cath.  There is no documentation for 93544, Aortic root.  Second, there is no documentation for selective renals, so you can't billed 36245 or 75724.  What you do bill is G0275 - Non Selective renals at time of heart cath.  For the iliacs, that is the correct code, non selective iliacs at time of heart cath - G0278.

HTH,
Jim Pawloski, CIRCC


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## dgarri (Oct 31, 2010)

Jim,
Thanks again - you have been very helpful to me in the past and I really appreciate it.  So I am going to us: 93510-26, 93543, 93556-26-59, 93545-59, 93555-26-59, G0275-59, G0278-59-22. Thanks agian.  You're the best.
Diana


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