# PFO Question - Color Doppler/Pulmonary vein Angiogram



## cweavercpc (Dec 22, 2009)

This is my first time coding PFO closures and so far it seems fairly easy.  If someone could please review this and double check me, I would greatly appreciate it. The dictation is as follows:

1. Right common femoral venous access.
2. Left common femoral venous access.
3. Intracardiac ultrasound of the right atrium, right ventricle, and intracardiac structures.
4. Color flow doppler across the interatrial septum and tricuspid valve.
5. Selective left pulmonary vein angiogram to determine the positioning of the catheter. 

Description: Left common femoral venous access was obtained using modified Seldinger technique and a 10-French introducer sheath was used to cannulate the left common femoral vein.  A St. Jude Medical intracardiac ultrasound was advanced under fluoroscopic guidance and put in the right atruim.  The right atrium size was enlarged.  There was evidence of moderate tricuspid regurgitation.  Interatrial septum was well visualized.  There was evidence of patent foramen ovale with a shunt present.  The mitral valve was well visualized and is free of any significant disease.  A SL sheath was advanced to the right atruim.  A multipurpose catheter was advanced across the interatrial septum with a wire.  The multipurpose catheter was positioned in the left pulmonary vein.  Sat was determined at the location of the catheter and was around 90% indicating positioning.  The pressure tracing in the left atruim was confirmed.  Selective left pulmonary vein angiogram was performed to confirm the positioning of the catheter, which was confirmed.  This sheath was exchanged to a long delivery Amplatzer sheath.  Heparin was given when we crossed the septum.  An 18mm Cribriform Amplatzer closure device was deployed successfully.  The position was confirmed with the intracardiac ultrasound, as well as by fluoroscopy and cine.  No complications.  ACT was more than 400. 

Impression:
1. Successful patent foramen ovale closure percutaneously through the right common femoral venous approach.
2. Intracardiac ultrasound of the heart. 



I know to bill the code 93580 and 93662. I have two questions.

1.  Can you bill for the color flow doppler +93325? I know it is an add on code that does not list the 93662 as a "use in conjuction with" code, however the 93662 does not state it includes spectral or color flow doppler. 

2.  Also can you bill for the pulmonary vein angiogram will that always be inclusive? 

Any help or opinions would be greatly appreciated. 

Thanks!


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