# 2 caths same day



## Pillow1 (Jan 12, 2010)

ANY INPUT WOULD BE APPRECIATIVE
WE BILLED 2 CATHS IN ONE DAY AND BLUE CROSS DIDN'T PAY ON THE SECOND CATH. PLEASE REVIEW ..THANK YOU SO MUCH.
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

PROCEDURE DIAGNOSIS: 
Angina. 

POSTPROCEDURE DIAGNOSIS: 
Severe obstructive coronary artery disease. 

OPERATION PROCEDURE: 
1. Left ventriculogram. 
2. Coronary angiogram. 
3. Left subclavian angiogram. 
4. Left heart catheterization. 
5. PTCI of the SVG to the PDA. 
6. PTCI x2 of the SVG to the OM 1. 
7. PTCA x2 to the proximal and mid circumflex. 


FINDINGS: 
1. Occluded SVG to the ramus. 
2. Patent LIMA to the LAD. 
3. Occluded LAD and RCA disease. 

4. A 75% mid body lesion in the SVG to the PDA that was 
successfully stented with a drug-eluting stent. 
5. SVG to the OM with 2 lesions, 90% at mid body and 80% in the 
distal anastomosis, both stented with drug-eluting stents. 
6. A 90% proximal circumflex and 75% mid circumflex. Both 
lesions successfully ballooned. 
7. Normal left ventricular function with an EF of 60%. 

COMPLICATIONS: 
Please see next dictation regarding dissection and thrombus formation 
in the vein graft. 

WE BILLED THIS FIRST PROCEDURE AS SUCH AND RECEIVED PAYMENT ON ALL OF THE BELOW CODES

93510
 36215-59
93543
 75685-2659
93545
 92980-RC
93555-2659
 92981-LC
93556-2659



*******THEN THE  SECOND PROCEDURE WAS DONE ON THE SAME DAY***


Acute stent thrombosis. 

POSTPROCEDURE DIAGNOSES: 
1. Dissection and thrombosis of the proximal SVG to the OM 1. 
2. Distal edge dissection of the mid SVG to the PDA stent. 

OPERATIVE PROCEDURES: 
1. IVUS of the SVG to the OM 1. 
2. Coronary angiogram. 
3. PTCI x2 to the SVG to the OM 1. 
4. Thrombectomy of the SVG to the OM 1. 
5. IVUS of the SVG to the PDA. 
6. PTCI of the SVG to the PDA. 
ANESTHESIA: 
IV Versed and fentanyl with local lidocaine. 



FINDINGS: 
1. Dissection with subtotal occlusion of the ostial and 
proximal body of the SVG to the OM with thrombus, requiring 
thrombectomy and 2 drug-eluting stents. 
2. A 75% distal edge dissection of the SVG to the PDA mid body 
distal to the prior stent requiring a second stent Promus 3.0 x18. 
3. Patent circumflex. 

****WE CODED THIS AS****** 

92980-LC26
92981-RC76
93508-26
93545
93556-2676
92978-2659
92979-2659

**BUT BLUE CROSS PAID SOME AND  DENIED THESE FOLLOWING CODES**

92980 LC 76  DENIED
92981-RC76   PAID
93508-26      DENIED
93545           DENIED          
93556-2659   DENIED
92978-2659   PAID
92979-2659   PAID

***THANK YOU FOR TAKING THE TIME TO READ ! ****


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## tstaton (Feb 2, 2010)

Once you have have coded for the initial Aniogram, unless there has been a change in status, the Angiogram cannot be charged again.  Only the intervention can be charged.


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## dpeoples (Feb 2, 2010)

Pillow1 said:


> ANY INPUT WOULD BE APPRECIATIVE
> WE BILLED 2 CATHS IN ONE DAY AND BLUE CROSS DIDN'T PAY ON THE SECOND CATH. PLEASE REVIEW ..THANK YOU SO MUCH.
> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
> 
> ...



Well, I have a couple of thoughts on this case:
First procedure, I do not see support for 36215/75685. Evaluation of the LIMA should have been coded 93539 (no extra for catheter placement) and evaluation of the SVG should have been 93540. Evaluation of the subclavian (for which there are no findings) is usually done to see the LIMA and should not be separately reported.  I know you have received payment but I just wanted to be thorough.

For the second procedure, perhaps adding modifier 78 will help as this was clearly a complication of the first procedure, or you may just have to appeal and send all appropriate reports.

Also, on the second procedure, I think you could have also coded the thrombectomy (92973).

HTH


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