# Please advise-Help



## peeya (Aug 26, 2010)

Would you bill the these codes for the following procedure? Please help I am new to cardiology billing

93510-26
93545
93556-26
92980-LC-53

DESCRIPTION OF PROCEDURE:  Following informed consent, the patient was
brought to the cardiac catheterization laboratory where the right groin was
prepped and draped in the usual sterile fashion.  Xylocaine 8 mL of 1% was
infiltrated into the right groin for local anesthesia.  A 6-French sheath
was introduced into the right femoral artery upon 1st attempt using the
modified Seldinger technique.  A 6-French JL4 and 6-French JR4 catheters
were used for selective left and right coronary angiography respectively.
Subsequently after thorough review of the angiograms, it was decided to
proceed with an attempt to open the chronic total occlusion of the
circumflex artery.  A 6-French XB3.5 guide catheter was used to cannulate
the ostium of the left main artery, and after Angiomax administration, a
0.014 BMW wire was placed at the site of the stenosis.  Attempts to cross
the lesion were unsuccessful.  We therefore exchanged to a ChoICE PT wire,
which as well did not advance into the lesion.
At this point, given the patient's pre-existing anemia of uncertain
etiology, and also the significant disease of the RCA which requires
advanced interventional techniques, it was felt that it was of the patient
the benefit to abort further interventional techniques; that it was felt
better to proceed with surgical coronary revascularization as opposed to
interventional techniques.  All catheters were removed; however we 1st
inserted a pigtail catheter into the left ventricle, where pressure
measurements were obtained.  No cineventriculography was performed in order
to save contrast dye.  All catheters were removed as well as the sheath and
manual pressure was applied until very good hemostasis was obtained.  There
were no complications during the procedure.  The total amount of contrast
used was 100 mL.  Total fluoro time was 11.3 minutes.

HEMODYNAMICS:
1. Opening aortic pressure is 148/706/103.
2. Left ventricular pressure at baseline 140/14 with left ventricular
      end-diastolic pressure of 21 mmHg.
3. Final aortic pressure 145/60 6/96.
4. There was no significant gradient during pullback of the pigtail
      catheter from the left ventricle into the ascending aorta.

CORONARY ANATOMY:
1. The left main artery has no evidence of significant obstructive disease.

2. The left anterior descending artery reveals an eccentric proximal 60%
      lesion.
3. The circumflex artery reveals a 100% lesion.  It was attempted to cross
      this lesion with several wires, which proved to be unsuccessful,
      likely suggestive of a chronic total occlusion at this vessel.
      However, distal portions of the obtuse marginal branch of significant
      size are visible.
4. The right coronary artery has a very proximal origin of the sinoatrial
      branch.  It reveals a heavily calcified 80% ostial lesion.
5. There is a 90% lesion in the mid section.  There is diffuse
      arteriosclerosis.

RIGHT FEMORAL ANGIOGRAM:  The sheath entry point was utilized for
opacification.  There was no significant stenosis.

CONCLUSIONS:  This is a very pleasant male patient who recently experienced
an acute coronary event.  He was found to have significant triple-vessel
disease with 60% left anterior descending stenosis and 100% circumflex
stenosis, visualization of distal sections of the circumflex artery and the
obtuse marginal branches as well as a heavily calcified ostial right
coronary artery lesion and mid right coronary artery lesion.


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## 10marty (Aug 27, 2010)

I would just bill the diagnostic cath only.  Personally have not had alot of luck getting reimbursed.  If the hours in the lab were significant i would bill the cath as usual and then resubmit with documentation why doctor should receive additional reimbursement.

Marty


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## peeya (Aug 27, 2010)

So I should not bill for the failed PCI (92980-LC-53). Even though it is documented?


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## sbicknell (Aug 27, 2010)

He did pretty good documentation of the cath and the problems he had trying to do the PTCA and why he had to stop the procedure.  I would code

93510-26
93545
93556-26
92982-LC-53

I would code for an attempted/failed PTCA rather than a stent. He stated "it was decided to proceed with an attempt to open the chronic total occlusion of the circumflex artery."  No where in the report does it mention stent.

You will have to send his cath report. They may not pay on the PTCA but they will never pay if you don't submit


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