# Right Heart Cath and EKOS, pulmonary angiography question



## calorom2 (Nov 14, 2018)

Would this be just 93456-26 or am I also coding for the EKOS, pulmonary angiography or are they included? What codes am I using if so?

Thanks for your help/code suggestions!

PROCEDURES: 
1.    Right heart catheterization. 
2.    Pulmonary angiography. 
3.    EKOS catheter to the left pulmonary artery. 
4.    EKOS catheter to the right pulmonary artery. 

APPROACH: 
Right common femoral vein x2. 

INDICATIONS: 
Large bilateral pulmonary emboli. 

The risks and benefits of right heart catheterization and EKOS catheter 
placement were discussed with the patient.  She is agreeable to the 
procedure.  Consent was obtained. 

PROCEDURE IN DETAIL: 
The patient was prepped and draped in the normal fashion.  Ultrasound 
was used to visualize the right common femoral vein.  With ultrasound 
guidance, the common femoral vein was accessed and a 6-French sheath 
was introduced x2. 

Right heart catheterization was performed using a 6-French balloon-tipped 
PA catheter.  The mean RA pressure 10 mmHg, RV 43/5 and PA pressure 
44/14 mmHg.  The mean pulmonary artery pressure is 26 mmHg. Pulmonary 
angiogram showed the catheter in good placement. 

The Swan-Ganz catheter was exchanged over a guidewire.  An EKOS catheter 
was placed in the right and left pulmonary artery.  TPA infusion at 
1 mg/hour was initiated while in 
the cath lab.  EKOS catheters were sutured in place.  The patient was 
transferred back to the intensive care unit in stable condition.


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## Jim Pawloski (Nov 15, 2018)

calorom2 said:


> Would this be just 93456-26 or am I also coding for the EKOS, pulmonary angiography or are they included? What codes am I using if so?
> 
> Thanks for your help/code suggestions!
> 
> ...



I only see a RHC (no coronaries) and infusion for thrombolysis - arterial. I don't see any evidence of a pulmonary arteriogram performed. So I would code 93451 and 37211-50 for the bilateral EKOS catheter infusion.
HTH,
Jim Pawloski, CIRCC


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