# Right Heart Cath with Endomyocardial Biopsy



## AmandaM.318414 (Jan 20, 2016)

Hi, 
Can someone please help me confirm if it is ok to add modifier 59 to 93451 in this particular situation?  Our physicians do dozens of these procedures and I would like another opinion. I have included the pertinent portion of a sample procedure. 

RIGHT HEART CATHETERIZATION AND ENDOMYOCARDIAL BIOPSY PROCEDURE REPORT 

DATE OF PROCEDURE: XX/XX/2015
PROCEDURE: Right Heart Catheterization and endomyocardial biopsy 

Pre-Procedure Diagnosis: 
Status Post Orthotopic Heart Transplantation 

Post-Procedure Diagnosis 
Status Post Orthotopic Heart Transplantation 

INDICATIONS: 
Mr. XXXX is a XX y.o. male with history of CMY s/p OHT, who is undergoing routine surveillance endomyocardial biopsy and right heart catheterization. 

DESCRIPTION OF THE PROCEDURE: 
Ultrasound Site-Rite guidance and the right internal jugular vein was accessed with a standard needle using modified seldinger technique. There was return of dark, non-pulsatile blood. Flow was confirmed with aspiration and flushing and a 8F sheath was placed in right internal jugular vein. Central venous pressure was recorded. 

A 7 French Argon Medical biopsy forceps was introduced into the sheath and advanced into the right ventricle and oriented toward the interventricular septum under fluoroscopy. An endomyocardial biopsy was taken and the bioptome removed. The procedure was repeated to obtain up to a total of 3 samples. 

After the biopsies, a 7 French Swan-Ganz catheter was introduced through the sheath and advanced into the SVC, right atrium, right ventricle, pulmonary artery and pulmonary wedge positions under fluoroscopic and hemodynamic guidance. Pressures were recorded in each cardiac chamber. Cardiac output was obtained via thermodilution method. The Swan-ganz catheter was subsequently removed. The sheath was removed and hemostasis was obtained with direct manual pressure over the entry site for 10 minutes. There was no evidence of hematoma or bleeding. The patient left the unit in stable condition. Vitals and respiratory status remained unchanged during the procedure. 

CARDIAC HEMODYNAMICS: 
Pre-biopsy: 
Blood Pressure (cuff): 155/90
Right Atrial Pressure (mmHg): 5 v to 9
Heart Rate (bpm): 88

Post-biopsy: 
Blood Pressure (cuff, mmHg): 124/81 
Heart Rate (bpm): 87
Right Atrial Pressure (mmHg) mean: 5
Right Ventricle (mmHg): 25/5
Pulmonary Arterial Pressure (mmHg): 24/14
Pulmonary Capillary Wedge Pressure (mmHg):10
Cardiac Output (l/min): 6.9
Cardiac Index (l/min/sqm): 

IMPRESSION: 
1. Normal right side filling pressures. 
2. Normal left side filling pressures. 
3. Normal Pulmonary arterial pressure. 
4. Normal cardiac output / cardiac index. 

RECOMMENDATIONS: 
1. Outpatient Heart Transplant Follow Up. 
2. Echocardiogram post Heart Biopsy

Any help is greatly appreciated! 
Thank you,
Amanda M.
CPC Health Information Coder


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## espressoguy (Jan 20, 2016)

Yes and no.

Per the National Correct Coding Initiative Policy Manual:



> Endomyocardial biopsy requires intravascular placement of catheters into the right ventricle under fluoroscopic guidance. Physicians should not separately report a right heart catheterization or selective vascular catheterization CPT code for placement of these catheters. A right heart catheterization CPT code may be separately reportable if it is a medically reasonable, necessary, and distinct service performed at the same or different patient encounter. Fluoroscopy codes (e.g., CPT codes 76000, 76001) are not separately reportable for an endomyocardial biopsy.


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