# Stent- lad, ascending aortogram



## OPENSHAW (May 6, 2013)

Can someone tell me if this is correct?

Preop dx:
1.  Chest pain
2.  Coronary artery disease

postop dx:
1.  Coronary artery disease
2.  Angina pectoris
3.  Status post stenting to the left anterior descending

operation performed:
1.  Percutaneous transluminal coronary angioplasty/stent to the left anterior descending in 2 places.
2.  Percutaneous transluminal coronary angioplasty to the diagonal 1.

Reason for procedure:
The patient underwent a cardiac catheterization cpt code 93460, by another doctor in our group, the same day as this procedure being done.  After interpretation of the angiography, interpretation of the catheterization showed an 80% stenosis in the mid portion of the lad, and because of the patient's history of retrosternal chest pain with radiation to the neck and to her left arm mostly with exertion, sometimes at rest, it was decided to proceed with cardiac intervention.

Description of procedure:
After informed consent, the 6-french sheath that was placed, by another doctor in our group, was changed to a 7-gfrench sheath.  After this was done, the 1st catheter utilized was a 7-french q4.  The 7-french q4 was placed in the ostium of the left coronary.  After this was done, a 2- x 12-mm quantum with an 0.014 asahi prowater wire was placed in the ostium of the left ,main.  After this was done, the wire was advanced to the distal lad.  When the wire was advanced to the distal lad, the balloon was advanced to the lesion.  It was dialted to 8 atm.  After this was done, this balloon was pulled back and the wire was left in place, and a stent, 2.5- x 14-mm medtronic integrity, was placed in the proximal lesion and dialated to 14 atm.  After this was done, we realized that there were some st-segment e;levation in the anterior lead suggestive of loss of the diagonal 1.  After this was done, then it was decided to proceed with a run through.  A run- through ns wire was placed across the stent into the diagonal 1, and after this was placed there a 2- x 8-mm balloon was placed across the stent and dilated to 6 atm.  This balloon then was pulled back.  The balloon was placed through the struts into the diagonal and was dialated to 6 atm.  The balloon was pulled back, and the wire was also pulled back and placed into the diagonal 2.  After the run-through wire was in the diagonal 2, a 2.25- x 18-mm stent was placed distal to the 1st stent because at that time there was a lesion of approximately 60% to 705.  The balloon was dialated to 8 atm.  After the stent was placed, the balloon was pulled back to the site where the 2 stents approached each other, and the balloon was dialated to 14 atm.  After this was done, both the run-through and the   wire were pulled back and several pictures then were done to the left coronary artery.  Both diagonals were present.  The diagonal 1 showed some moderate flow, but it was open.  The diagonal 2 had a tight lesion in the ostium.  However, the prestent stenosis in the proximal portion was 80%, in the distal portion was about 60% to 70%.  The post-stent stenosis in the distal area of the lad was 0% and in the proximal portion of the lad was 0%.  The patient had some mild st-segment elevation post procedure, probably secondary to the diagonal branch; however, the patient became pain free and tolerated the procedure well and was sent to the recovery room in stable condition.  During the procedure, angiomax was used.  It was continued for 45 minutes after the procedure.  Also the anteriotomy was closed utilizing an 8-french angio-seal.  Again, the patient tolerated the procedure well.  She was sent to the recovery room in stable condition.  

Because of the complexity of the lesions both in the proximal lad that was also very calcified, the procedure took approximately an hour more than usual.

Would this be coded as:
92928-22, dx 413.9
93567, dx 414.00

would i put modifier ld with code 92928?  We have been have claims deny reg stent and modifier ld?


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## TWinsor (May 7, 2013)

I only see the 
92928 with diagnosis 414.01, 414.4

The 93567 is not billable with the intervention codes only heart cath codes. 

I do not see this being performed in your documentation.

HTH!


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