# Cardiac Cath Help!!!!



## dgarri (May 13, 2011)

My doctor gave me this to code.  Patient is inpt at the hospital, he was called for consult after the pt was transferred from another local hospital.  And at that time pt had already had a LHC done at the the other hospital and was in need of stenting.  So far I have this for the charges:   99223/25, 36000/59, 92980/59/CX, 98981/59/LD - it seems like something is missing? Could someone help me with this please.


Procedue:  Under sterile conditions and local anesthesia, a 5-french sheath was inserted percutaneously in the right femoral and a 6-french sheath in the right femoral artery.  Next, the guiding shots were obtained using a 6-french Judkins left 5 guiding catheter.  At that point, the decision was made to change the guiding catheter to XB LAD 4.  next, the patient was given 7000 units of heparin IV puch.  He was already on Plavix which was given at Fish Hospital (300 mg).  next, the totally occluded proximal first obtuse marginal branch was crossed using an 0.014 Fielder XT wire.  The lesion was predilated using a Mini Trek 2.0 x 12mm balloon.  Next, a Mini Vision stent 2.5 x 18mm was advanced across the lesion and was fully expanded up to 12 atmospheres.  next, the decision was made to proceed with stenting to the distal LAD.  A new wire was used.  A BMW 0.014 wire was advanced across the distal LAD lesion and the lesion was stented using a 2.0 x 18mm Mini Vision stent.  Following full stent expansion, there was no residual stenosis. 

The patient tolerated the procedure well.  At the end of the procedure, a hand injection was done through the side arm of the sheath in the right common femoral artery and hemostasis was obtained by using Angio-Seal.

Summary  of hemodynamics: The heart rate was 77 beats per minute.  Arterial blood pressure was 100/60.

Summary of the Coronary Artereis:  The circumflex showed a proximal 50% concentric stenosis.  The circumflex gave rise to the large first obtuse marginal branch which was totally occluded at its proximal portions.  The circumfled proper was a samll nondominant vessel.  Following stenting to the proximal circumflex and to the totally occluded first obtuse marginal branch, there was no residual stenosis and no evidence of lacal dissection.  The LAD showed minor irregularitites.  There was a tubular 80% stenosis in the distal LAD as it wrapped around the apex.  Following  stenting the to the distal LAD, there was no residual stenosos and no evidence of lacal dissection.

Summary: Successful stenting to a 50% stenosis in the proximal circumflex, successful angioplasty and stenting to a totally occluded proximal first obtuse marginal branch of the circumflex.  Successful stenting to the distal left anterior descending.  All 3 stents were bare metal stents.


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## dgarri (May 13, 2011)

*Cath help!*

I think I got it!! its the cath code that is missing for 2010 it was 93508/26, but if I am not mistaken it is now 93454 for no coronaries.  If this is incorrect or any advice on this cath please let me know.  I would appreciate any input.  Happy Friday all 

Thanks
Diana G.


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## dphillips (May 13, 2011)

You cannot use the 36000 with the stent code as it is included in the procedure. Medicare CCI edit:

13. Cardiac catheterization and percutaneous coronary artery interventional procedures such as angioplasty, atherectomy, or stenting include insertion of a needle and/or catheter, infusion, fluoroscopy and ECG rhythm strips (e.g., CPT codes 36000, 36120, 36140, 36160, 36200-36248, 36410, 96360-96376, 71034, 76000-76001, 93040-93042). All these services are components of a cardiac catheterization or percutaneous coronary artery interventional procedure and are not separately reportable.

Also, I don't see in the notes where he actually did a selective angio so I wouldn't code that either.

So I would code the E/M with the 25 modifier and then code 92980-LC and 92981-LD. No 59 modifier is needed.

Dawn CPC, CCC


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## drsnpatil (May 13, 2011)

*cardiac cath.*

Need to code only two codes as per procedure note 92980-LC and 92981-LD. No supportive documentation to code E/M services along with stent placement.


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## dphillips (May 13, 2011)

Yes.......I was assuming she had a seperate progress note for the admit.



Dawn CPC, CCC


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## dgarri (May 16, 2011)

I do have a seperate consult note then the cath.  Thank you both for your help.


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## OliviaPrice (May 16, 2011)

I just wanted to give a bit of clarification here.....just in case those reading did not know.

Even if your physician did a complete heart cath it is no longer a separately billable service once stenosis has been identified by another diagnostic method including previous cath, MRA, CTA etc...(even if your physician is not the one that performed the original study) unless there has been a change in the patient's status since the original diagnostic study and can be supported by medical necessity.


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