# How would you code this?



## jdmjine (Dec 14, 2017)

Procedures performed
1. Left heart catheterization
2. left ventriculogram
3. aortic arch angiogram

A 6 French terumo sheath was placed in the right radial artery. Once the sheath was inserted, 1mg verapamil and 300 mcg of nitroglycerin was injected through the sheath. 5000 units of heparin was given through the IV. Selective coronary angiogram was then performed using a 6 French JL 3.5 catheter and a 5 French JR4 diagnostic catheter. a pigtail catheter was advanced into the aortic arch and hand injection angiogram was performed to try to visualize the subclavian artery and left internal mammary artery. There is poor filling of those vessels, but they did appear to be patent. The JR4 catheter prior to its being removed was advance over a J-wire across the aortic valve into the left ventricular cavity. The left ventricular pressure was measured along with hand injection left ventriculogram. The patient tolerated the procedure without incident. At the end of the case, the catheter and sheath were removed with adequate hemostasis using a TR band.                                                  93458 26 and what other code to use? Another coder at work wants to use 37221, but that's for Pta and stent. Some help would be appreciated


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## surber09 (Dec 15, 2017)

I would use 93567.  But why the 93458?  If it was just a LHC and Ventriculogram wouldn't 93452 be correct (no coronaries)?


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## Jim Pawloski (Dec 18, 2017)

I would use 93459, Left Heart Cath w/ Bypass grafts, because the LIMA was imaged to see if it could be used for a bypass graft.

HTH,
Jim Pawloski, CIRCC


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## jdmjine (Dec 20, 2017)

Jim Pawloski said:


> I would use 93459, Left Heart Cath w/ Bypass grafts, because the LIMA was imaged to see if it could be used for a bypass graft.
> 
> HTH,
> Jim Pawloski, CIRCC



thank you that is good to know. I am a new coder and still have a lot of learning to do when it comes to coding cardiology.


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## jdmjine (Dec 20, 2017)

p1nayrima said:


> thank you that is good to know. I am a new coder and still have a lot of learning to do when it comes to coding cardiology.



Jim, here is another one that I need help with

Procedure: Complex aortogram with bilateral lower extremity runoff

a 4-french sheath was placed in the left common femoral artery. Intent was to advance the catheter up and over the aortoiliac bifurcation and perform selective right lower extremity angiography with selective catheter positioning. A 4 French UF catheter was advanced to the mid abdominal aorta and mid abdominal aortography was performed with digital subtraction. the catheter was pulled down to the distal abdominal aorta and distal abdominal aortography was performed with digital subtraction. Attempts were then made to advance the 4 French uf catheter over aortoiliac bifurcation. A 0.035 glidewire was taken and advanced down the catheter into the right proximal SFA. the UF catheter was unable to advanced over this wire into the right iliac system due to angulation of the aortoiliac bifurcation. Subsequently, the wire was changed out for exchange length Glidewire, which was advanced into the mid SFA. The UF catheter was removed and a straighttipped 65 cm glide 4-french glide catheter was taken and was able to be advanced down to the level of the external iliac artery on the right. RIght lower extremity angiogram was then performed with digital subtraction. the catheter was pulled removed and left lower extremity angiography was performed with digital subtraction via injection of the left common femoral artery sheath. pt tolerated the procedure without incident. 

75630 26? and what else

thank you


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## Jim Pawloski (Dec 20, 2017)

p1nayrima said:


> Jim, here is another one that I need help with
> 
> Procedure: Complex aortogram with bilateral lower extremity runoff
> 
> ...



Since the renals are not described, I would only bill 75716 and 36247-RT.
HTH,
Jim


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## jdmjine (Dec 28, 2017)

I am teaching myself cardiology coding but I am having a hard time coding legs! Jim do you know any good resources/materials that can help me code these procedures, I would really appreciate it! I have another one where I need help coding again.


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## jdmjine (Dec 28, 2017)

Jim Pawloski said:


> Since the renals are not described, I would only bill 75716 and 36247-RT.
> HTH,
> Jim




I am teaching myself cardiology coding but I am having a hard time coding legs! Jim do you know any good resources/materials that can help me code these procedures, I would really appreciate it! I have another one where I need help coding again


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## Jim Pawloski (Jan 2, 2018)

p1nayrima said:


> I am teaching myself cardiology coding but I am having a hard time coding legs! Jim do you know any good resources/materials that can help me code these procedures, I would really appreciate it! I have another one where I need help coding again



Z Health Publishing has excellent books to use as resource material. I use it all the time. They are pricey, but if there hasn't been too many changes in the codes they can be used for an extended period of time.
Send me your new case.

HTH,
Jim


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