# Right + Left Heart Cath



## amym (Jun 10, 2014)

Is it appropriate to code this as 93460-26? 

PROCEDURES PERFORMED: 

--  Right heart catheterization. 
--  Left heart catheterization. 
--  Left coronary angiography. 
--  Right coronary angiography. 
--  Quick Clot Closure. 
--  Quick Clot Closure. 


DISPOSITION: The patient left the catheterization laboratory in stable 
condition. The patient will be discharged on the day of the procedure, 
following bed rest and subsequent ambulation, provided the recovery 
parameters are appropriate. The patient has been instructed to call the 
procedural cardiologist immediately if symptoms recur, or should there be 
any problems with the puncture site, such as bleeding, swelling, pain or 
signs of infection. 

INDICATIONS: Cardiac: aortic valve disease. BICUSPID AV, SEVERE AS, PREOP 
PRIOR TO AVR 

HEMODYNAMICS: Hemodynamic assessment demonstrates normal cardiac output 
and mildly elevated pulmonary capillary wedge pressure. There is mild 
pulmonary hypertension. 

VENTRICLES: NO LV GRAM PERFORMED. DID NOT CROSS THE HEAVILY CALCIFIED AND STENOTIC BICUSPID AV. 

CORONARY VESSELS: The coronary circulation is right dominant. Coronary 
angiography demonstrated minor luminal irregularities. Left main: Normal. 
LAD: Angiography showed minor luminal irregularities. Circumflex: 
Angiography showed minor luminal irregularities. RCA: Angiography showed 
minor luminal irregularities. 

PROCEDURE: The risks and alternatives of the procedures and conscious 
sedation were explained to the patient and informed consent was obtained. 
The patient was brought to the cath lab and placed on the table. The 
planned puncture sites were prepped and draped in the usual sterile 
fashion. 

--  Right femoral artery access. The puncture site was infiltrated with 
local anesthetic. The vessel was accessed using the modified Seldinger 
technique, a wire was threaded into the vessel, and a sheath was advanced 
over the wire into the vessel. 

--  Right femoral vein access. The puncture site was infiltrated with 
local anesthetic. The vessel was accessed using the modified Seldinger 
technique, a wire was threaded into the vessel, and a sheath was advanced 
over the wire into the vessel. 

--  Right heart catheterization. A catheter was advanced to the pulmonary 
artery wedge position. 

--  Left heart catheterization. A catheter was advanced to the ascending 
aorta. After recording ascending aortic pressure, the catheter was 
advanced across the aortic valve and left ventricular pressure was 
recorded. Imaging was performed using an RAO projection. 

--  Left coronary artery angiography. A catheter was advanced to the aorta 
and positioned in the vessel ostium under fluoroscopic guidance. 
Angiography was performed in multiple projections using hand-injection of 
contrast. 

--  Right coronary artery angiography. A catheter was advanced to the 
aorta and positioned in the vessel ostium under fluoroscopic guidance. 
Angiography was performed in multiple projections using hand-injection of 
contrast. 

--  Quick Clot Closure.. 

--  Quick Clot Closure.. 


STUDY DIAGRAM 

HEMODYNAMIC TABLES 

Pressures:  Baseline 
Pressures:  - HR: 68 
Pressures:  - Rhythm: 
Pressures:  -- Aortic Pressure (S/D/M): 123/69/78 
Pressures:  -- Pulmonary Artery (S/D/M): 31/15/21 
Pressures:  -- Pulmonary Capillary Wedge: 18/15/14 
Pressures:  -- Right Atrium (a/v/M): 12/9/7 
Pressures:  -- Right Ventricle (s/edp): 34/12/-- 

O2 Sats:  Baseline 
O2 Sats:  - HR: 68 
O2 Sats:  - Rhythm: 
O2 Sats:  -- AO: 13.1/95/17.15 
O2 Sats:  -- PA: 13.1/72/12.94 

Outputs:  Baseline 
Outputs:  -- CALCULATIONS: Age in years: 70.16 
Outputs:  -- CALCULATIONS: Average Partial Oxygen - PA: 40.00 
Outputs:  -- CALCULATIONS: Average Partial Oxygen - SA: 78.00 
Outputs:  -- CALCULATIONS: Body Surface Area: 2.32 
Outputs:  -- CALCULATIONS: Height in cm: 191.00 
Outputs:  -- CALCULATIONS: Sex: Male 
Outputs:  -- CALCULATIONS: Weight in kg: 103.00 
Outputs:  -- OUTPUTS: CO by Fick: 6.30 
Outputs:  -- OUTPUTS: Fick cardiac index: 2.71 
Outputs:  -- OUTPUTS: Fick HR: 66.00 
Outputs:  -- OUTPUTS: O2 consumption: 265.01 
Outputs:  -- OUTPUTS: Vo2 Indexed: 114.21 
Outputs:  -- RESISTANCES: Left ventricular stroke work: 81.79 
Outputs:  -- RESISTANCES: Left Ventricular Stroke Work index: 35.25 
Outputs:  -- RESISTANCES: Pulmonary vascular index (dsc): 206.34 
Outputs:  -- RESISTANCES: Pulmonary vascular index (Wood Units): 2.58 
Outputs:  -- RESISTANCES: Pulmonary vascular resistance (dsc): 88.92 
Outputs:  -- RESISTANCES: Pulmonary vascular resistance (Wood Units): 1.11 
Outputs:  -- RESISTANCES: PVR_SVR Ratio: 0.10 
Outputs:  -- RESISTANCES: Right ventricular stroke work: 17.63 
Outputs:  -- RESISTANCES: Right ventricular stroke work index: 7.60 
Outputs:  -- RESISTANCES: Systemic vascular index (dsc): 2092.88 
Outputs:  -- RESISTANCES: Systemic vascular index (Wood Units): 26.17 
Outputs:  -- RESISTANCES: Systemic vascular resistance (dsc): 901.93 
Outputs:  -- RESISTANCES: Systemic vascular resistance (Wood Units): 11.28 
Outputs:  -- RESISTANCES: Total pulmonary index (dsc): 619.02 
Outputs:  -- RESISTANCES: Total pulmonary index (Wood Units): 7.74 
Outputs:  -- RESISTANCES: Total pulmonary resistance (dsc): 266.77 
Outputs:  -- RESISTANCES: Total pulmonary resistance (Wood Units): 3.34 
Outputs:  -- RESISTANCES: Total vascular index (Wood Units): 28.75 
Outputs:  -- RESISTANCES: Total vascular resistance (dsc): 990.85 
Outputs:  -- RESISTANCES: Total vascular resistance (Wood Units): 12.39 
Outputs:  -- RESISTANCES: Total vascular resistance index (dsc): 2299.22 
Outputs:  -- RESISTANCES: TPR_TVR Ratio: 0.27 
Outputs:  -- SHUNTS: Pulmonary flow: 6.30 
Outputs:  -- SHUNTS: Qp Indexed: 2.71 
Outputs:  -- SHUNTS: Qs Indexed: 2.71 
Outputs:  -- SHUNTS: Systemic flow: 6.30
476212


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## dblakema@svmh.com (Jun 10, 2014)

93460 is correct. In addition I am not familiar with quit clot closure.  If it is an occlusive device used in venous or arterial access sites for closure then 
G0269 should be charged for cardiac procedures according to the NCCI policy manual.
Thank you,
Dorothy Blakeman, CCS, CCS-P, CCC, CDIP


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## Shipman.Meric (Jun 14, 2014)

*code LHC?*

I would not code the LHC due to this statement:
VENTRICLES: NO LV GRAM PERFORMED. DID NOT CROSS THE HEAVILY CALCIFIED AND STENOTIC BICUSPID AV. 

My understanding is a LHC requires crossing of the aortic valve whether or not an LV was performed. 

M.Shipman, CPC-A, MLT (ASCP)


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## theresa.dix@tennova.com (Jun 17, 2014)

Shipman.Meric said:


> I would not code the LHC due to this statement:
> VENTRICLES: NO LV GRAM PERFORMED. DID NOT CROSS THE HEAVILY CALCIFIED AND STENOTIC BICUSPID AV.
> 
> My understanding is a LHC requires crossing of the aortic valve whether or not an LV was performed.
> ...



And then there is this part of the report. Contradicting.

-- Left heart catheterization. A catheter was advanced to the ascending 
aorta. After recording ascending aortic pressure, the catheter was 
advanced across the aortic valve and left ventricular pressure was 
recorded. Imaging was performed using an RAO projection.


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## Shipman.Meric (Jun 17, 2014)

theresa.dix@ethc.com said:


> And then there is this part of the report. Contradicting.
> 
> -- Left heart catheterization. A catheter was advanced to the ascending
> aorta. After recording ascending aortic pressure, the catheter was
> ...



Standard template,   a request for a corrected report would certainly be in order. 

M.Shipman CPC-A, MLT (ASCP)


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## theresa.dix@tennova.com (Jun 17, 2014)

shipman.meric said:


> standard template,   a request for a corrected report would certainly be in order.
> 
> m.shipman cpc-a, mlt (ascp)


yes


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