# 75710-26-59?



## amym (Jul 27, 2011)

Is it appropriate to append a -59 modifier to CPT 75710-26 for given procedure?

PROCEDURES PERFORMED: 

--  Left heart catheterization with ventriculography. 
--  Left coronary angiography. 
--  Right coronary angiography. 
--  Right common femoral angiography. 
--  Coronary Bare Metal Stent Placement. 
--  Intervention on OM1: stent. 

RECOMMENDATIONS: 
The patient should continue with the present medications. 

INDICATIONS: Angina/MI: stable angina. 

PRIOR DIAGNOSTIC TEST RESULTS: Nuclear stress test was positive. There was 
ischemia in the territory of the circumflex. 

VENTRICLES: There were no left ventricular global or regional wall motion 
abnormalities. Global left ventricular function was normal. EF calculated 
by contrast ventriculography was 60 %. 

VALVES: AORTIC VALVE: The aortic valve was evaluated by left 
ventriculography. The aortic valve appeared to be structurally normal. The 
aortic valve leaflets exhibited normal thickness and normal excursion. 
There was no aortic stenosis. MITRAL VALVE: The mitral valve was evaluated 
by left ventriculography. The mitral valve appeared grossly normal. The 
mitral leaflets exhibited normal thickness and normal excursion. The 
mitral valve exhibited no regurgitation. 

CORONARY VESSELS: The coronary circulation is right dominant. There was 
1-vessel coronary artery disease (circumflex). Left main: Normal. LAD: 
Angiography showed minor luminal irregularities. 1st obtuse marginal: 
There was a discrete 80 % stenosis at the site of a prior stent. RCA: 
Angiography showed minor luminal irregularities. 

RIGHT LOWER EXTREMITY VESSELS: Right leg angiography was limited to the 
common femoral and the proximal portion of the superficial femoral and 
deep femoral arteries. These vessels appeared normal. 

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. 

--  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. Ventriculography was performed using power injection of contrast 
agent. 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. 

--  Right common femoral angiography. A catheter was positioned under 
fluoroscopic guidance. 

LESION INTERVENTION: A stent was performed on the lesion in the 1st obtuse 
marginal. 

--  Vessel setup was performed. A Runway 6F LBU 3.5 guiding catheter was 
used to cannulate the vessel. 

--  Vessel setup was performed. A BMW HT 190cm wire was used to cross the 
lesion. 

--  A INTEGRITY 2.5 X 14 bare-metal stent at a maximum inflation pressure 
of 12 atm. 

CARDIAC INTERVENTIONS 
--  Coronary Bare Metal Stent Placement. 

COMPLICATIONS: 
There were no adverse outcomes. 
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING: 
Test started at 09:05. Test concluded at 09:45. RADIATION EXPOSURE: 
Fluoroscopy time: 5.8 min. 
MEDICATIONS GIVEN: 
Midazolam, 1 mg, IV, at 09:01. 
Midazolam, 1 mg, IV, at 09:06. 
Midazolam, 1 mg, IV, at 09:35. 
Fentanyl, 50 mcg, IV, at 09:36. 
Labetalol (Trandate), 5 mg, IV, at 09:00. 
Bivalirudin (Angiomax), 13 ml, IV, last dose at 09:25. 
Bivalirudin (Angiomax), infusion rate of 30 ml/hr, IV, last dose at 09:38. 
Clopidogrel (Plavix), 600 mg, PO, last dose at 09:38. 
Aspirin, 325 mg, PO, last dose at 09:44. 
CONTRAST GIVEN: 
Omnipaque 130 ml.


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## Jess1125 (Jul 27, 2011)

Personally, I don't think the 75710-26 is even separately billable at all. It's not entirely clear to me why the femoral angiography was done for but I don't think it was for diagnostic reasons. 

May have been to see if a closure device could be placed? 

Other opinions on this one? 

Jessica CPC, CCC


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## jewlz0879 (Jul 27, 2011)

amym said:


> Is it appropriate to append a -59 modifier to CPT 75710-26 for given procedure?
> 
> PROCEDURES PERFORMED:
> 
> ...



I agree with jess1125. I don't see any medical necessity and per his findings "they are normal." Furthermore, you need to be certain that if billing 75710-26-59 you follow the new rules. 

CPT 2011 has also restructured the way we can bill for diagnostic angiography. Diagnostic angiography performed at the time of an interventional procedure is separately reportable if:

I.                    No prior catheter-based angiography study is available and a full diagnostic study is performed, and the decision to intervene is based on the diagnostic study, OR

II.                  Prior study is available, but as documented in the medical record:

A.      The patient's condition with respect to the clinical indication has changed since the prior study, OR

B.      There is inadequate visualization of the anatomy and/or pathology, OR

C.      There is a clinical change during the procedure that requires new evaluation outside the target area of intervention

I personally do not believe I'd bill for it. Hope that helps!


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## amym (Jul 27, 2011)

Thank you all for your help!


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## dpeoples (Jul 27, 2011)

amym said:


> Is it appropriate to append a -59 modifier to CPT 75710-26 for given procedure?
> 
> PROCEDURES PERFORMED:
> 
> ...




Angiography of the access site is not separately billable w/o documented medical neccesity independent of the reason for the heart cath/angiography/intervention.

I would not code 75710.

HTH


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