# Cardiac catheterization



## JRC (Aug 31, 2009)

Hi All,

Please confirm my codes for the below procedure.
*93510-26,93543,93555-26,93545,93556-26,75710-26,59,G0269*

BLOOD LOSS:
About 15-20 mL.

TOTAL CONTRAST USED:
151 mL.

FLUORO TIME:
12.05 minutes.

COMPLICATIONS:
Nil.

PROCEDURE:
The procedure was done to the right groin.  The patient has had 1 mg of
Versed as conscious sedation.  Under local anesthesia, right femoral artery
was entered in the first attempt, anterior wall punctured, and 6-French
arterial sheath was put in.  The procedure was done without any
anticoagulation.  The patient was also given Mucomyst before the procedure
because of mild elevation of serum creatinine level of 1.4.

Using 6-French left coronary catheter, selective left coronary arteriogram
was done in multiple views.  This catheter was replaced by 6-FR4 diagnostic
catheter and selective right coronary arteriogram was done in multiple views.
This catheter was replaced with the pigtail catheter and pigtail catheter
was advanced into the left ventricle.  It produced multiple PVCs because it
was jumping between the apex and when it is withdrawn it would come out of
the left ventricle.  In the process of getting it into the left ventricle
again without wire was made and it crossed the loop into the catheter just
above the sheath.  This took quite a bit of time _____ .  It seems that the
closed lumen completely.  The guidewire of 0.35 was attempted to pass without
any success.  Then, I tried _____ again without success.  Then, I made
counterclockwise rotation, undid the loop, passed the guidewire, and then
over the wire the pigtail catheter was removed.  This was changed to another
pigtail catheter and catheter was again advanced into the left ventricle.
After recording the pressures, the left ventriculogram was done.

Catheter and the wires were removed.  Right femoral arteriogram was done.
Angio-Seal was deployed.  The patient tolerated the procedure well.

INTERPRETATION:
1.  LEFT HEART CARDIAC CATHETERIZATION.  THE LV PRESSURE WAS 128/14 AND
DIASTOLIC PRESSURE 19 MMHG.  AORTIC PRESSURE GRADIENT WAS 150/28 WITH MEAN OF
85, BUT THIS IS OF COURSE BECAUSE OF OVERSHOOT.  THERE WAS NO GRADIENT ACROSS
THE AORTIC VALVE.
2.  CORONARY ARTERIOGRAM.
A.  LEFT MAIN CORONARY ARTERY 4.25 MM IN DIAMETER, LESS THAN 10% LESION
DISTALLY.
B.  LAD HAS A STENT PROXIMALLY.  IT IS PATENT.  REST OF THE LAD AND ITS D1
BRANCH, WHICH IS 1.75 MM DIAMETER, PATENT.   LAD ITSELF IS 3.25 MM IN
DIAMETER.
C.  CIRCUMFLEX.  THIS ALSO HAS A STENT PROXIMALLY.  IT IS A 2.25 TO 2.5 MM
VESSEL.  IT GIVES INTO HIGH OM BRANCH, WHICH CAN ALSO BE CONSIDERED AS
INTERMEDIUS.  OTHER BRANCHES OM2 AND OM3 ARE PATENT.  NO LESIONS.
D.  RCA IS A 4 MM VESSEL, HAS A STENT PROXIMALLY.  THERE IS NO STENOSIS AND
THERE IS NO LESION IN THE RCA OR ITS BRANCHES LV POSTERIOR BRANCH AND THE PDA
BRANCH.  THERE ARE NO COLLATERALS.
3.  RIGHT FEMORAL ARTERIOGRAM.  THE PUNCTURE IS ABOVE THE BIFURCATION AND
THERE IS NO LESION OR ANY LEAK.  THE PATIENT TOLERATED THE PROCEDURE WELL.

CONCLUSIONS:
This is an essentially normal study in terms of having no hemodynamic
lesions.  All the stents are patent.

Thanks,
JRC, CPC


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## drsnpatil (Aug 31, 2009)

Its correct coding.


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## Jim Pawloski (Aug 31, 2009)

JRC said:


> Hi All,
> 
> Please confirm my codes for the below procedure.
> *93510-26,93543,93555-26,93545,93556-26,75710-26,59,G0269*
> ...



I agree with the heart cath codes, but the 75710 cannot be coded since 1) the femoral injection is part of the closure device code and 2) the report does not describe the full extremity.


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## JRC (Aug 31, 2009)

Thank you

_JRC CPC_


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## dpeoples (Sep 1, 2009)

You should not code the 75710. Evaluation of the access site is necessary for the procedure and should not be separately billed, w/wo closure device.
HTH


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## deeva456 (Sep 1, 2009)

I agree with the other coders, you cannot bill for 75710 or G0269. Both are bundled with the heart cath.

Dolores, CPC-CCC


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## Jim Pawloski (Sep 2, 2009)

deeva456 said:


> I agree with the other coders, you cannot bill for 75710 or G0269. Both are bundled with the heart cath.
> 
> Dolores, CPC-CCC



Sorry to disagree with you, but G0269 is used for closure device use as in angioseal, vasoseal, perclose or other devices.  

Thanks,
Jim


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## dpeoples (Sep 3, 2009)

Jim Pawloski said:


> Sorry to disagree with you, but G0269 is used for closure device use as in angioseal, vasoseal, perclose or other devices.
> 
> Thanks,
> Jim



It may be appropriate IMHO, to report the closure device for the facility billing (hospital supplies), and for tracking purposes. It should not be billed for the professional component of the service as the payment for closure is built into the payment for the service, ie no additional payment is made. (per CCI)

HTH


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## Jim Pawloski (Sep 3, 2009)

dpeoples said:


> It may be appropriate IMHO, to report the closure device for the facility billing (hospital supplies), and for tracking purposes. It should not be billed for the professional component of the service as the payment for closure is built into the payment for the service, ie no additional payment is made. (per CCI)
> 
> HTH



I agree with you on that.  I just disagreed with the comment that the g-code was bundeled with the procedure.
Have a great holiday weekend!!!!
Jim Pawloski


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## spaustat (May 20, 2010)

*Cath lab supplies*

I'm new to hospital billing.  What supplies are included in the facility charge for a heart cath?  Or maybe an easier question - are any supplies separately payable for a heart cath - if so which ones.  I'm getting bills for guidewire, transducer, custom cath lab kit, etc.  

Thanks,
Helen, CPC


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