# Is it 93458?



## amym (Oct 25, 2011)

Is it still appropriate to bill as 93458?

PROCEDURES PERFORMED: 

--  Left heart catheterization. 
--  Left coronary angiography. 

RECOMMENDATIONS: 
The patient should continue with the present medications. 
The patient's anti-anginal regimen should be further intensified. 

INDICATIONS: Angina/MI: stable angina. 

CORONARY VESSELS: The coronary circulation is right dominant. Small 
non-flow limiting dissection noted at the distal LMCA/LAD ostium. This is 
unchanged from previous image from yesterday and is felt to be stable. 

Ramus lesion is also unchanged and since it is a small vessel, best 
treatment option is medical therapy. Mid LAD: There was a 100 % stenosis. 
1st diagonal: There was a 99 % stenosis. Mid circumflex: Angiography 
showed minor luminal irregularities. 

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. 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. 

COMPLICATIONS: 
There were no adverse outcomes. 
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING: 
Test started at 09:48. Test concluded at 10:00. RADIATION EXPOSURE: 
Fluoroscopy time: 0.7 min. 
HEMOSTASIS: 
The sheath was removed. The site was compressed manually. Hemostasis was 
successful.


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## KXB4A0 (Oct 25, 2011)

*93458*

Yes, you can bill 93458, the description states coronary artery(s) so you can bill it even if they only image one.


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## Misty Dawn (Oct 25, 2011)

Not sure you can bill for this because it sounds like from the above dictation that a HTC was done the day before.  If a HTC was done the day before you will need to find out from the doctor why it was being performed agian the next day (i.e. medical necessity).  I do not see a statement/reason why the pt returned to the cath lab.


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## theresa.dix@tennova.com (Oct 26, 2011)

Misty Dawn said:


> Not sure you can bill for this because it sounds like from the above dictation that a HTC was done the day before.  If a HTC was done the day before you will need to find out from the doctor why it was being performed agian the next day (i.e. medical necessity).  I do not see a statement/reason why the pt returned to the cath lab.



The physician should have said recurrent angina maybe? But yes this is a LHC since the aortic valve was crossed.


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