# Help with coding Cath



## dgarri (Jun 9, 2010)

I am new at coding and would like some assistance with coding a Left Heart Cath.  My cardiologist gave me charges for : 

Left heart cath + bilat selective carotid + second order + Lima + rt iliac.
So here's what I did:
93510 (26), 93543 (59), 93556 (26) (59) , 93545 (59), 93555 (26) (59), G0278, (59) 75662 (59), 36216 (59), 93539, does the 75662 cover the Lt/Rt Carotid or do I need to code that seperately. Please let me know if this is correct.  I am learning as I go so any input would be greatly appreciated.

Thanks
Dgarri


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## Jim Pawloski (Jun 9, 2010)

dgarri said:


> I am new at coding and would like some assistance with coding a Left Heart Cath.  My cardiologist gave me charges for :
> 
> Left heart cath + bilat selective carotid + second order + Lima + rt iliac.
> So here's what I did:
> ...




Can you post the report?  Need to know where the catheter went for the carotid angio, and what was imaged for the carotids.  Did he just imaged the neck or did he image the cerebral vessles also?  The cardiac portion looks good to me.
Thanks,
Jim Pawloski, CIRCC


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## dgarri (Jun 9, 2010)

*Report on cath / Procedure and Summary*

Under sterile conditions and local anesthesia, a 6-French sheath was inserted percutanelusly in the right femoral artery and the coronaries were visualized using a 6-French Judkins left 4 and 6-French 3 DRC.  The left ventriculogram was done using a 6-French pigtail.  The right and left carotid arteries were visualized using a 6-French 3 DRC for the left coronary and a 6-French multipurpose catheter for the right coronary artery.  Multiple other catheters were used including a SIM-I catheter for the right carotid artery.  At the end of procedure, a hand injection was done through the side arm of the sheath in the right common femoral artery and hemostasis was obtained by using Angio-Seal.

Summary of Hemodynamics: The heart rate was 70 beats per minute. Arterial blood pressure was 140/70.  Left ventricular pressure was 140/20.

Summary of the Left Ventriculogram:  This was done in the RAO projuction.  There was mild global hypokinesis with and overall ejection fraction around 45%.  There was no mitral regurgitation.

Summary of the Carotid Arteries: The left carotid artery was selectively visualized.  The left carotid artery gave rise to a left external and left internal carotid artery both of which were normal.  There was no disease in the left common carotid artery and no disease in the left internal carotid artery.

The left subclavian artery was visualized in order to assess the LIMA suitability.  There is a fold in the left subclavian artery with a 70% stenosis as a result of the fold in the left subclavian artery .  The LIMA appeared to be normal in caliber and free of disease.  the LIMA appeared to be suitable for use during bypass surgery. 

The right brachiocephalic artery could not be selectively visualized despite using multiple catheters.  Eventually, a hand injection was done at the origin of the right brachiocephalic artery.  I was unable to accurately assess the right internal carotid artery.  An MRA or a CT angiography may be needed to assess the right internal carotid artery and the right common carotid artery.  

Summary of the Coronary Arteries: The left main was normal.  The circumflex was a medium-sized vessel which gave rise to a first obtuse marginal branch.  The circumflex and obtuse marginal branch were free of disease.

The LAD showed a 90% concentric stenosis immediately proximal to the branching point of the first diagonal branch.  Immediately distal to the first diagonal distal LAD wrapped around the apex and appeared to be normal in caliber.  The diagonal branch was free of disease.

The right coronary artery showed a tubular 60% stenosis in the midportion.  Otherwise, the right coronary artery showed minor irregularities and was a donminant vessel.

Jim,  I hope this helps - If you need any thing else please let me know. I really do appreciate your help.  Thanks so much.


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## Jim Pawloski (Jun 10, 2010)

dgarri said:


> Under sterile conditions and local anesthesia, a 6-French sheath was inserted percutanelusly in the right femoral artery and the coronaries were visualized using a 6-French Judkins left 4 and 6-French 3 DRC.  The left ventriculogram was done using a 6-French pigtail.  The right and left carotid arteries were visualized using a 6-French 3 DRC for the left coronary and a 6-French multipurpose catheter for the right coronary artery.  Multiple other catheters were used including a SIM-I catheter for the right carotid artery.  At the end of procedure, a hand injection was done through the side arm of the sheath in the right common femoral artery and hemostasis was obtained by using Angio-Seal.
> 
> Summary of Hemodynamics: The heart rate was 70 beats per minute. Arterial blood pressure was 140/70.  Left ventricular pressure was 140/20.
> 
> ...



This does help.  I would code the carotids this way;
36215-rt for the right innominate artery
36215-lt-59 for the left carotid artery
36125-lt-59 for the lt subclavian artery
75756 - S&I for lt Internal Mammary
75676 - S&I for Lt common Carotid
75710 - S&I for Innomiate Artery

As I stated before, the coronary charges look good to me.
I hope this helps you out.  Let me know if you have any more questions.

Thanks,
Jim Pawloski, CIRCC, R.T.(R)(CV)


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## dpeoples (Jun 11, 2010)

dgarri said:


> Under sterile conditions and local anesthesia, a 6-French sheath was inserted percutanelusly in the right femoral artery and the coronaries were visualized using a 6-French Judkins left 4 and 6-French 3 DRC.  The left ventriculogram was done using a 6-French pigtail.  The right and left carotid arteries were visualized using a 6-French 3 DRC for the left coronary and a 6-French multipurpose catheter for the right coronary artery.  Multiple other catheters were used including a SIM-I catheter for the right carotid artery.  At the end of procedure, a hand injection was done through the side arm of the sheath in the right common femoral artery and hemostasis was obtained by using Angio-Seal.
> 
> Summary of Hemodynamics: The heart rate was 70 beats per minute. Arterial blood pressure was 140/70.  Left ventricular pressure was 140/20.
> 
> ...



hi dgarri,
I am not Jim but I see this a little different than he does. I agree with most of the codes he gave you but with a few minor differences. When coding a heart cath, some of the rules regarding interventional radiology do not apply, For instance:

When the R/L IMA is being considered for bypass during a heart cath the code I use is 93539 instead of the radiology code 75756. 

Also, I don't like the documentation for the catheter placement concering the carotid arteries so at most I would only code 36215 for the LT Common Carotid. The other shots could have been done in the arch (at vessel origin).I would code the imaging portion 75676. 

HTH


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## dgarri (Jun 11, 2010)

Hi Danny,

So you are saying I should be coding like this:
93510 (26) 93543 (59), 93556 (26) (59), 93545 (59), 93555 (26) (59), G0278 (59), 36216 (59), 93539 (59), 36215 (lt) (59), 75676 (59).

And that should cover it all.  Am I correct?

Thanks so much,
Diana


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## dpeoples (Jun 11, 2010)

dgarri said:


> Hi Danny,
> 
> So you are saying I should be coding like this:
> 93510 (26) 93543 (59), 93556 (26) (59), 93545 (59), 93555 (26) (59), G0278 (59), 36216 (59), 93539 (59), 36215 (lt) (59), 75676 (59).
> ...



My scenario would be:
93510-26
93556-26
93555-26
93539
93545
93543
36215 (LT CC)
75710 (LT Subcl) there are sufficient diagnostic findings to charge this
75676 (LT CC)

I do not see a second order selection (36216), nor would I bill for evaluation of the access site (G0278 ? ). The brachiocephalic could not be visualized (no interpretation) so I also would not bill for that. You should not need to apply modifier 59. I hope I covered everything.

HTH


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## jtuominen (Jun 11, 2010)

Without a pre-procedural indication of CP radiating down the arm or additional information relating that the right carotids could not be visualized due to something like right innominate stenosis, I would not charge for the 36215 and 75710 for the right innominate artery. You've got to have intent to study the extremity or a solid diagnosis to support that charge and I don't see it in the report. Worth an addendum if you can't find a diagnosis mentioned elsewhere.

I agree with the 93539 charge instead of 75756. 75756 with 93510 cannot be billed together even with a modifier 59 on the 75756. It will get denied no matter what payer you are dealing with.

I came up with 

36215
75676

93510
93543
93545
93555
93556

93539  

Wouldn't bill for the extra 36215 and 75710 without additional diagnosis support.
No 59s needed for this code set.

Jayna
RHIA, CIRCC


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## dgarri (Jun 11, 2010)

Wow - thanks for all your help everyone.  It is greatly appreciated.
Diana


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