# 93459 + Bypass Angio?



## amym (Dec 15, 2011)

Physician turned in charges for LHC + Grafts and Bypass Angio.  I have attached a report and am not sure how to code the Bypass Angio.  Please help!

SUMMARY: 

--  CARDIAC STRUCTURES: 
--  Global left ventricular function was normal. EF estimated was 60 %. 

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

PROCEDURES PERFORMED: 

--  Left heart catheterization with ventriculography. 
--  Left coronary angiography. 
--  Right coronary angiography. 
--  Saphenous vein graft angiography. 
--  LIMA graft angiography. 

RECOMMENDATIONS: 
EF60%, no MR, R dominant. LM has LI. LCX has LI. Small ramus has ostial 
70%. LAD has LI. RCA has distal 50% stenosis before the crux. VG to distal 
RCA is widely patent. LIMA to LAD is atretic and subtotalled. Medical 
therapy and risk factor modification. 

INDICATIONS: chest pain and abnormal stress test 

HEMODYNAMICS: Hemodynamic assessment demonstrates moderate systemic 
hypertension. 

VENTRICLES: There were no left ventricular global or regional wall motion 
abnormalities. Global left ventricular function was normal. EF estimated 
was 60 %. 

VALVES: MITRAL VALVE: The mitral valve exhibited no regurgitation. 

CORONARY VESSELS: The coronary circulation is right dominant. non 
obstructive coronary artery disease, atretic LIMA. Left main: Angiography 
showed minor luminal irregularities. LAD: Angiography showed mild 
atherosclerosis. Circumflex: Angiography showed mild atherosclerosis. 
Ramus intermedius: The vessel was very small sized. There was a 70 % 
stenosis at the ostium of the vessel segment. RCA: Angiography showed mild 
atherosclerosis. There was a 50 % stenosis in the distal third of the 
vessel segment. Graft to the LAD: The graft was a LIMA. There was a 99 % 
stenosis at the distal anastomosis. 

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. 

--  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. Ventriculography was performed using power injection of contrast 
agent. 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. 

--  Saphenous vein graft angiography. A catheter was advanced to the aorta 
and positioned at the aortic anastomosis of the graft under fluoroscopic 
guidance. Angiography was performed in multiple projections using 
hand-injection of contrast. 

--  Left internal mammary graft angiography. A catheter was advanced to 
the aorta and positioned at the aortic anastomosis of the graft under 
fluoroscopic guidance. Angiography was performed in multiple projections 
using hand-injection of contrast. 

COMPLICATIONS: 
None occurred during the cath lab visit. 
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING: 
Test started at 09:30. Test concluded at 10:17. RADIATION EXPOSURE: 
Fluoroscopy time: 20.7 min. 
MEDICATIONS GIVEN: 
Midazolam, 1 mg, IV, at 09:30. 
CONTRAST GIVEN: 
Omnipaque 160 ml. 

STUDY DIAGRAM 

Angiographic findings 
Native coronary lesions: 
7Ramus intermedius: Lesion 1: 70 % stenosis. 
7RCA: Lesion 1: 50 % stenosis. 

Coronary graft lesions: 
7Graft to LAD: LIMA  7 99 % stenosis at distal anastomosis. 

HEMODYNAMIC TABLES 

Pressures:  NO PHASE 
Pressures:  - HR: 53 
Pressures:  - Rhythm: 
Pressures:  -- Aortic Pressure (S/D/M): 202/61/112 

Outputs:  NO PHASE 
Outputs:  -- CALCULATIONS: Age in years: 85.37 
Outputs:  -- CALCULATIONS: Body Surface Area: 1.60 
Outputs:  -- CALCULATIONS: Height in cm: 157.00 
Outputs:  -- CALCULATIONS: Sex: Female 
Outputs:  -- CALCULATIONS: Weight in kg: 60.10


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## Jess1125 (Dec 15, 2011)

amym said:


> Physician turned in charges for LHC + Grafts and Bypass Angio.  I have attached a report and am not sure how to code the Bypass Angio.  Please help!
> 
> SUMMARY:
> 
> ...



The 93459 is correct. That would be the only code. The grafts/IMA is included in this code. 

Jessica CPC, CCC


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## johns4377 (Dec 15, 2011)

93459 is apropriate code...


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