# PCI + Cath



## amym (Apr 4, 2013)

Should I be billing this as 92928-LC, 92921-LD and 93458-26-59? Thanks for your help.

SUMMARY: 

--  1ST LESION INTERVENTIONS: 
--  A percutaneous intervention was performed on the lesion in the 
proximal RCA. 

--  2ND LESION INTERVENTIONS: 
--  A percutaneous intervention was performed on the 95 % lesion in the 
1st obtuse marginal. 

PROCEDURES PERFORMED: 

--  Left heart catheterization with ventriculography. 
--  Left coronary angiography. 
--  Right coronary angiography. 
--  Interventional Flow Wire. 
--  PTCA. 
--  Coronary Drug Eluding Stent Placement. 
--  Intervention on proximal RCA: percutaneous intervention. 
--  Intervention on OM1: percutaneous intervention. 

INDICATIONS: Coronary artery disease: abnormal stress test. 

HEMODYNAMICS: Hemodynamic assessment demonstrates normal hemodynamics. 

CORONARY VESSELS: The coronary circulation is right dominant. 

(1) Left main is patent with no significant disease 
(2) LAD is patent with no significant disease 
(3) LCX is patent with no significant disease- OM1 is a moderate sized 
vessel with proximal 95% stenosis. 
(4) RCA has a 40-45 percent mid lesion. 
(5) LVgram not performed. 
(6) FFR of RCA is 0.89 
(7) PCI of OM1 with a 2.25 x 12mm DES. 

. Ostial left main: Normal. Proximal left main: Normal. Mid left main: 
Normal. Distal left main: Normal. Proximal LAD: Normal. Mid LAD: Normal. 
Distal LAD: Normal. Proximal circumflex: Normal. Mid circumflex: Normal. 
Distal circumflex: Normal. 1st obtuse marginal: There was a 95 % stenosis. 
Ostial RCA: Normal. Proximal RCA: Normal. There was a 40 % stenosis. Mid 
RCA: Normal. Distal RCA: Normal. Angiography showed minor luminal 
irregularities. Right posterolateral segment: 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. Oxygen 2 L/min. 

--  Right radial 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 catheter 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. 

LESION #1 INTERVENTION: A percutaneous intervention was performed on the 
lesion in the proximal RCA. There was no dissection. 

--  Vessel setup was performed. A 175cm Certus Pressure wire was used to 
cross the lesion. 

--  Vessel setup was performed. A Runway 6FR FR4 guiding catheter was used 
to cannulate the vessel. 

--  Steady baseline values were obtained. Mean arterial pressure and mean 
distal coronary pressures were then obtained at maximum hyperemia. 

LESION #2 INTERVENTION: A percutaneous intervention was performed on the 
95 % lesion in the 1st obtuse marginal. There was no dissection. 

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

--  Vessel setup was performed. A 175cm Certus Pressure wire was used to 
cross the lesion. 

--  , using a Emerge Rx 2.0 x 12mm balloon, with 1 inflations and a 
maximum inflation pressure of 14 atm. 

--  Vessel setup was performed. A Runway 6FR 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. 

--  Vessel setup was performed. A 175cm Certus Pressure wire was used to 
cross the lesion. 

--  A Resolute Integrity Rx 2.25 x 14mm drug-eluting stent at a maximum 
inflation pressure of 16 atm. 

CARDIAC INTERVENTIONS 
--  Interventional Flow Wire. 

--  PTCA. 

--  Coronary Drug Eluding Stent Placement. 

COMPLICATIONS: 
None occurred during the cath lab visit. 
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING: 
Test started at 07:49. Test concluded at 09:13. RADIATION EXPOSURE: 
Fluoroscopy time: 19.2 min. 
HEMOSTASIS: 
The site was compressed with a Hemoband device. Hemostasis was successful. 
MEDICATIONS GIVEN: 
Midazolam, 1 mg, IV, at 07:49. 
Fentanyl, 50 mcg, IV, at 07:49. 
Midazolam, 1 mg, IV, at 08:18. 
Fentanyl, 50 mcg, IV, at 08:18. 
Fentanyl, 50 mcg, IV, at 08:25. 
Midazolam, 1 mg, IV, at 08:25. 
Nitroglycerin, 100 mcg, IA, at 07:58. 
Verapamil (Isoptin, Calan, Covera), 2.5 mcg, IA, at 07:58. 
Adenosine (Adenocard), 90 mcg, intracoronary, at 08:28. 
Adenosine (Adenocard), 120 mcg, intracoronary, at 08:31. 
Heparin, 2500 units, IA, last dose at 07:58. 
Heparin, 8000 units, IV, last dose at 08:16. 
Heparin, 5000 units, IV, last dose at 08:47. 
1% Lidocaine, 5 ml, subcutaneously, at 07:57. 
Prasugrel, 60 mg, PO, at 09:15. 
CONTRAST GIVEN: 
Omnipaque 200 ml. 


STUDY DIAGRAM 

Angiographic findings 
Native coronary lesions: 
7OM1: Lesion 1: 95 % stenosis. 
7Proximal RCA: Lesion 1: 40 % stenosis. 
Intervention results 
Native coronary lesions: 
7 percutaneous intervention of proximal RCA. 
7percutaneous intervention of the 95 % stenosis in OM1. Stent: Resolute 
Integrity Rx 2.25 x 14mm drug-eluting. 

HEMODYNAMIC TABLES 

Pressures:  Baseline 
Pressures:  - HR: 67 
Pressures:  - Rhythm: 
Pressures:  -- Aortic Pressure (S/D/M): 122/65/90 

Outputs:  Baseline 
Outputs:  -- CALCULATIONS: Age in years: 70.64 
Outputs:  -- CALCULATIONS: Body Surface Area: 1.95 
Outputs:  -- CALCULATIONS: Height in cm: 173.00 
Outputs:  -- CALCULATIONS: Sex: Male 
Outputs:  -- CALCULATIONS: Weight in kg: 80.70


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## RhondaJohnson (Apr 4, 2013)

This note is confusing to me.  I read this as he did pressure measurments in 'lesion one', and the the ptca balloon and stent were done in 'lesion two'.

93458-26-59
93571
92928-LC

I could be wrong, this note is much different than I'm use to seeing.  But under 'lesion one' he doesn't mention inflating a balloon, only taking measurements.


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## kimberlybaggott@gmail.com (Apr 4, 2013)

*ama*

if you will google the ama convention for new cardiology codes. there is a great power point that tells exactly how to code.  the new code include in the global package the left heart cath, the coronary angiography or angioplasty.  and then the intervention.  becareful the last few codes are for AMIs and occulision.  if you also have time google the procedures and watch them.  this is how i learned exactly how the procedures are done or if you have doctors like mine, i can get the doctor to sit down with me and watch the youtube and explain what he did different. if you need any other help you can text me at 3345581087. i can always use a new cardiology coding buddy.


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## ilovemyboys777@yahoo.com (Apr 9, 2013)

93458-26-59
92928-LC
92920-RC

I wouldn't code 92921 because that is an addision vessel.  LC and RC is two different vessels.  I didn't see where angioplasty was done in the LD. 
However, I could be wrong this note is also confusioning to me as well.


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## Amanedmaiston (Apr 20, 2013)

93458-26,59 (LHC)
92928-LC  (stent)
92920-RC    ( i really can't tell what he did here but If you have verified it was a plasty it is 92920. I would ask him to ammend) )
93571-26   (FFR don't forget to bill this)


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