# Right & left heart cath vs right cath



## sschauster (Mar 24, 2017)

I am new to cardiology coding and am struggling with this cath report. Any suggestions or tips you may have would be greatly appreciated!
I have a report that states that a R&L heart cath and selective coronary angiography was performed. 
The findings of the aortic, pulmonary capillary wedge, pulmonary artery, right ventricular, right atrial pressures are listed as well as the 02 saturations all indicating a right heart cath.
He then goes on to discuss the coronary angiography. He lists the left main coronary artery, the left anterior descending artery, the circumflex an right coronary artery. The physician is saying that he did a right and left heart cath but the cath lab is saying it was a right heart cath only. 
How can you do a coronary angiogram of the left coronary arteries without performing a left heart cath?


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## aarias1206 (Mar 25, 2017)

*R&L Heart Cath with Selective Coronary Angiography*



sschauster said:


> I am new to cardiology coding and am struggling with this cath report. Any suggestions or tips you may have would be greatly appreciated!
> I have a report that states that a R&L heart cath and selective coronary angiography was performed.
> The findings of the aortic, pulmonary capillary wedge, pulmonary artery, right ventricular, right atrial pressures are listed as well as the 02 saturations all indicating a right heart cath.
> He then goes on to discuss the coronary angiography. He lists the left main coronary artery, the left anterior descending artery, the circumflex an right coronary artery. The physician is saying that he did a right and left heart cath but the cath lab is saying it was a right heart cath only.
> How can you do a coronary angiogram of the left coronary arteries without performing a left heart cath?



Good evening. So I was reading your post. I have been coding Cath & Electrophysologist procedures for 8 years now. It can be quite confusing. Coronary Angiography is used to injection dye to visualize the artery of the heart. The code is 93460/ 26 modifier add. The use of this code included your coronary angiography, with or without left ventricular. Your op report must support that a Right heart catheterization was performed and a Left heart catheterization was performed. Now here is the tricky part. If the physician originally plan to do the bilateral Cath and they ended up doing a Right heart catheterization then the code would be 93456/26, now the Cath lab has the actual films to determine if one or both was done. If they are telling you the the RHC was done then that is correct. Then the physician would need to do an addendum to correct his op report to reflect that. Also this year was change. All Cath and coronary intervention codes the moderate sedation are now separately billable it's no longer included in the cpt codes as of January 2017. I can tell you that according to the information you posted. The physician did a RHC with coronary angiography. 93456/26. If he use moderate sedation on his patient he would need to also document that he was the Supervision of moderate sedation intra-service time the first 15 =99152
Supervision for subsequent 45 minutes = 99153. 
For example fyi. 93456/26, 99152, 99153X3 total time 60 mins moderate sedation. I would be happy to help in anyway I can. If you have any further questions my email aarias1125@gmail.com.
I hope I have given you information that will help you understand. 

Thx u Angelic Arias, CPC


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