# Help - Left Heart Cath coding



## peeya (Aug 4, 2010)

I am new to hospital billing can some one please help me code the following procedure:

Left heart catheterization.
2. Coronary angiography.
3. Saphenous vein graft angiography.
4. Left internal mammary artery angiography.

CONCLUSION: Two-vessel coronary artery disease with 3 grafts patent.
1. Left main: Normal.
2. Left anterior descending: Mild disease.
3. Circumflex: 70% proximal to mid disease.
4. Obtuse marginal 1: 100% occluded and distal obtuse marginal occluded.
5. Right coronary artery: 100% proximal occlusion.
6. Left internal mammary artery is ungrafted.
7. Saphenous vein graft to obtuse marginal is patent.
8. Saphenous vein graft to posterior descending artery and distal circumflex patent.
9. No left ventriculogram.

PLAN: Medical therapy.

HISTORY: The patient is a 76-year-old gentleman with a history of
bypass surgery in 2000 with recurrent chest pain and known renal
insufficiency. The patient was taken to the cath lab.
DESCRIPTION OF PROCEDURE: Informed consent was obtained from the
patient. The patient was premedicated and brought to the cath lab
where he was sterilely prepared, draped and locally anesthetized. The
right femoral artery was cannulated using the Seldinger technique,
and a 6-French Hemaquet sheath was inserted. Thereafter, bilateral
angiography, aortography, LIMA angiography and SVG angiography were
performed. The procedure was tolerated without any complications.
Thereafter, a StarClose device was deployed.

LEFT VENTRICULOGRAM: Left ventriculogram was not performed due to
renal insufficiency.

CORONARY ANGIOGRAM: Left main: Normal

LAD: The left anterior descending artery is a medium-sized vessel and
courses around the apex. There is no evidence of disease.

Circumflex: The left circumflex artery is a medium-sized vessel. There is 70% proximal and mid disease. Obtuse marginal 1 is 100%
occluded.

RCA: The right coronary artery is a medium-sized vessel. There is 100% proximal occlusion.

LIMA is ungrafted.

SVG to OM 1 is patent. SVG to PDA/distal circumflex probable sequential graft is patent.


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## Jim Pawloski (Aug 4, 2010)

peeya said:


> I am new to hospital billing can some one please help me code the following procedure:
> 
> Left heart catheterization.
> 2. Coronary angiography.
> ...




Try this;
93510- If pressures were taken.  Otherwise 93508.
93539- Lima
93540 -Grafts
93445 - Coronaries
93556 - S&I Coronaries

HTH,
Jim Pawloski, CIRCC


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## armymomryan (Aug 9, 2010)

Jim Pawloski said:


> Try this;
> 93510- If pressures were taken.  Otherwise 93508.
> 93539- Lima
> 93540 -Grafts
> ...



 I'm pretty sure Jim meant 93545, not 93445


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## adennis (Oct 5, 2010)

*can you use 36246*

If they are doing a LT heart cath and they access the Rt Com Fem artery can you bill the 36246?


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## Jim Pawloski (Oct 5, 2010)

adennis said:


> If they are doing a LT heart cath and they access the Rt Com Fem artery can you bill the 36246?



No you cannot.  It is part of the Left heart cath.  Also 36246 is a second order selective below the diaphram.

HTH,
Jim Pawloski, CIRCC


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