# left heart cath;and addt



## maryann1224@bellsouth.net (Aug 30, 2012)

*Lt heart cath/addtl venous access*

PROCEDURE IN DETAIL:
After obtaining informed consent, the patient was transported to
the cath lab where he was prepped and draped in sterile fashion.
Lidocaine 2% was used to infiltrate the skin and subcutaneous
tissue overlying the right common femoral artery and vein and over
the left common femoral artery.  Percutaneous access was obtained
in the right common femoral artery utilizing a Seldinger technique
and a 6-French sheath was placed.  Percutaneous access was
obtained in the right common femoral vein and a 5-French venous
sheath was placed.  I then then obtained percutaneous access in
the left common femoral artery utilizing a Seldinger technique and
placed an 8-French sheath for intra-aortic balloon pump. I
advanced a JL-4 catheter to the left coronary artery, found the
patient to be hypotensive and performed angiography demonstrating
a thrombotic occlusion within the stent in the proximal LAD.  At
this time we advanced the intra-aortic balloon pump under
fluoroscopic guidance into the descending aorta and activated.  We
then proceeded with intervention on the left anterior descending
artery as described below.  Following completion of the procedure
we performed right coronary angiography with a JR-4 catheter.  We
crossed the aortic valve with a JR-4 catheter and performed RAO
ventriculogram.


INTERVENTION:
Following initial coronary angiography we proceeded with the
intervention.  As noted above the intra-aortic balloon pump was
placed and then the left main was engaged with an EBU 3.75 guide
catheter.  A run-through wire was advanced through the thrombotic
occlusion in the LAD.  I then advanced an Angiojet aspiration
thrombectomy catheter down the left anterior descending artery
performing mechanical aspiration thrombectomy.  Following
completion of Angiojet procedure we had restoration of TIMI-3 flow
with no perforation, dissection, or distal embolization. The
stent appeared widely patent.  There is no residual visible
thrombus in the LAD.  We then completed angiography and returned
then with an Eagle Eye platinum IVUS catheter.  I advanced this
catheter down the left anterior descending artery to assess the
stent in the LAD.  We found the stent to be fully opposed
throughout its length.  It was fully expanded.  There was no
significant voids visualized behind the stent and there is no
evidence of significant residual thrombus.  After removal of our
wires we completed final angiography demonstrating TIMI-3 flow
with no perforation, dissection, or distal embolization. The
patient was transferred to the ICU with the intra-aortic balloon
pump in place.


IS THE CORRECT CODE 92973 FOR ASPIRATION AND WHAT IS CODE FOR ADDTL ACCESS?  THANK YOU!!!


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## maryann1224@bellsouth.net (Aug 31, 2012)

*my question is that the access*

sight is included in the heart cath, but when they do an additional access for example to place an intra aortic balloon pump..is that billable?

"additional venous access"


thank you.....


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## talwell (Aug 31, 2012)

I would not code the additional access. From the additional access you made it to the aorta (36200) and 36200 is bundled with the insert of the IABP. 36200 is also bundled into the cath and cannot be billed separate with any modifier even though it is a separate access.

93454-26
92978-26
93799
33967

92973 is for mechanical thrombectomy during a stent or angioplasty. If no angioplasty or stent is being billed I would bill it with the unlisted procedure 93799.


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## maryann1224@bellsouth.net (Sep 5, 2012)

thank you!


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## 634sg4fs65g4fg (Sep 7, 2012)

I do not agree, Angiojet is billable and I would code 92973. I am curious, you chose the IVUS ultrasound 92978, is that what the Eagle Eye Cath is? I have never heard of that but would think it was a type of cath and not ultrasound? Thanks


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