# LT+RT Heart Cath +



## amym (Jul 12, 2011)

Is it appropriate to bill 93460-26 and 93567 for the following case?

SUMMARY: 

--  CORONARY CIRCULATION: 
--  There was 1-vessel coronary artery disease ( 30 % LAD). 

--  HEMODYNAMICS: 
--  Hemodynamic assessment demonstrates mild systemic hypertension. 

PROCEDURES PERFORMED: 

--  Right heart catheterization. 
--  Left heart catheterization. 
--  Left coronary angiography. 
--  Right coronary angiography. 
--  Ascending aortography. 

RECOMMENDATIONS: 
The patient should continue with the present medications. 

INDICATIONS: Cardiac: aortic valve disease. 

HEMODYNAMICS: Not done as Aortic valve was not crossed Hemodynamic 
assessment demonstrates mild systemic hypertension. 

VENTRICLES: Aortic valve could not be crossed due to severe stenosis and 
angulation. 

CORONARY VESSELS: The coronary circulation is right dominant. There was 
1-vessel coronary artery disease ( 30 % LAD). There was no angiographic 
evidence for occlusive coronary artery disease. Left main: Normal. Mid 
LAD: There was a 30 % stenosis. Circumflex: Normal. RCA: 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. 

--  Right femoral vein 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. 

--  Right heart catheterization. A catheter was advanced to the pulmonary 
artery wedge position under fluoroscopic guidance. Measurements of 
pressures and arterial and venous oxygen saturation were obtained. The 
catheter remained in place throughout the procedure for continuous 
monitoring of pulmonary artery pressure. 

--  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. 

--  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. 

--  Ascending aortography. A catheter was placed and contrast was 
injected.


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## karah*1976 (Jul 12, 2011)

*93460-26 93567*

I would agree with these codes. The 2011 Coders Desk Reference for Procedures states 93567 is specific to the visualization of the valves above the aorta and it's branches. 

The dictations represents this by the following:

HEMODYNAMICS: Not done as Aortic valve was not crossed Hemodynamic 
assessment demonstrates mild systemic hypertension. 

VENTRICLES: Aortic valve could not be crossed due to severe stenosis and 
angulation.


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## dpeoples (Jul 12, 2011)

amym said:


> Is it appropriate to bill 93460-26 and 93567 for the following case?
> 
> SUMMARY:
> 
> ...





 I see an interpretation of the coronary vessels (in bold) but not of the valves/ascending aorta. I also see contradicition concerning the left heart cath, under procedures it says the aortic valve was crossed and left ventricular pressures obtained, but at the beginning of the report is says the opposite. hmm? I think perhaps this was a canned procedural report and l would code on the side of caution.  I have:
93456 Rt Heart cath and coronaries.


HTH


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