# coronary angiongraphy and angiography of saphenous vein



## bevann0402@bellsouth.net (Jun 26, 2014)

Still a little stumped, but getting there!!!  Thanks to everyone again for all the help you have been giving!!

besides the cpts codes, how would I go able looking this one up so that I can make a note in my cheat book for future reference.  I know how to look up the coronary angiography. I think I will be looking at codes that have the wording for "bypass grafts" due to numbers # 3 and 4; so I should just have one cpt code that will cover all this, but right now I am clueless (!!lol)

procedure performed:
1. 6-french sheath placement in the right common femoral artery
2. coronary angiography
3. angiography of saphenous vein graft to PDA
4. angiography of the stump of the saphenous vein graft to obtuse margin
5. right common femoral artery angiography

details explained,. consent signed.  The patient was transferred to the coronary suite, prepped and draped in the usual sterile fashion. underwend 6-french sheath placement in the right common femoral artery without difficulty. coronary angiography is then performed.

the left main is large and long without significant occlusions. left circumflex large, nondominant, tapers to a small vessel. it just has mild, less than 30% diffuse disease ostial to proximal. obtuse marginal #1 is large without significant occlusions. Obtuse marginal #2 is medium sized vessel without significant occlusions.

left anterior descending artery is large without significant occlusions. diagonal artery #1 large. no significant occlusions. patient underwent angiography of the right coronary artery.  RCA is large, dominant. no significant occlusions seen. posterior descending artery is large, no significant occlusions. the patient underwent angiograpy of the saphenous vein graft to OM. it is occluded proximally in the proximal portion of the graft. the patient then underwent angiography of the saphenous vein to PDA, which is a medium sized vessel but widely patent without significant occlusions. the patien has known severe cardiomyopathy. he has had nuclear imaging showing LVEF less than 20% as well as echo recently showing EF less than 20%. dye conservation is held. the patient did not undergo left heart catheterization or left ventriculogram. at the close of case, he did undergo angiography of the right common femoral artery which shows heavy calcifications, mild diffuse disease. it is at the bifurcation, not recommended for angio-seal. the patient underwent manual removal with good hemostasis. no hematoma.

thanks again so much!!
Beverly


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## mceisele (Jun 27, 2014)

Hi Beverly, 

Yes, I agree with one code for the  bypass angiography (93455-26).  Since the report reads, ".. the patient did not undergo left heart catheterization or left ventriculogram.." you should not use 93459 because this includes the LHC.

You can make up your own cheat sheet or purchase one from one of the IR coding companies.  I simply use the plastic tabs that came with my book to mark pages 562-564.

As far as diagnosis codes, I would code the saphanous vein graft occlusion as first (ICD9--414.02)  (for ICD-10,   I25.810 [if no angina pectoris]).

HTH.
Celeste


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## bevann0402@bellsouth.net (Jun 27, 2014)

Thanks so much.  I have ordered a DVD of a webinar I couldn't attend live and am slowing adding to my stash of information.  This doctor starting working out of our office about a month ago, and I was selected to do his coding since I am the only certified coder on staff.  I am enjoying learning something new, but it is mind boggling at time!!

Thanks again, this forum has been a life saver!!

Beverly


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## jambam4 (Jun 28, 2014)

i will send you my billing sheets that i created.  and my Dr Z sheets that i use as well.  and dr dunn's 2013 cardiology overview powerpoint.  it will explain quite a bit for you.

since they changed everything in 2011, most everything is bundled into 1 code for heart caths.  always look for key words in your reports, and if you need to, ask your doctor to help you out, especially with his/her dictation.


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