Coding Cheney:
VPs Recent Coronary History Makes Good Cardiology Coding Primer
Published on Wed Aug 01, 2001
Three times in the last eight months, Vice President Dick Cheney has checked into George Washington Hospital in Washington, D.C., due to persistent heart problems.
In the latest episode (June 29-30), an electrophysiology (EP) study was performed that indicated the need for an internal cardioverter-defibrillator (ICD). The implantation was performed the same day.
The main events in Cheney's coronary history over the past year cover a wide range of procedures, including EP services, cardiac catheterizations, coronary interventions and other services.
The following timeline includes the main procedures performed on Cheney up to November 2000, along with associated signs and symptoms and/or diagnoses. Without operative reports from these sessions, which have not been released, it is impossible to know with certainty the correct CPT or ICD-9 codes. But based on information released by George Washington Hospital and the White House, most of the procedures appear readily identifiable:
1978: Cheney has first heart attack, age 37
1984: Cheney has second heart attack
1988: Cheney has third heart attack, followed by quadruple bypass surgery
1996: Cardiac catheterization reveals no change.
Nov. 22, 2000
Cheney checks into hospital, complaining of chest pain. An ECG is performed, after which he was taken to the cath lab for a left heart cath. Coronary angiography indicates that the diagonal branch off Cheney's left anterior descending artery had a 90 percent blockage. This leads to a percutaneous transluminal coronary angioplasty (PTCA), followed by stent placement to support the artery and prevent a recurrence of the blockage.
Subsequently, Cheney's physicians reveal that a small portion of myocardium, or heart muscle, had died due to lack of oxygen arising from the blocked coronary artery.
March 5, 2001
The vice president goes to the George Washington University Medical Center after two brief episodes of chest pain. He is taken to the cath lab, and a cardiac catheterization is performed. After coronary angiography reveals that the diagonal branch of the left anterior descending artery, which was stented in November, has a small area of significant (90 percent) restenosis, Cheney's cardiologist, Dr. Jonathan Reiner, MD, performs a PTCA to dilate the area.
In a news conference after the revascularization, Reiner noted that about 20 percent of patients who receive stents experience renarrowing or restenosis. "It's a different process than atherosclerosis, which occurs over a period of many decades. This is a specific response to injury from the stent," he said, adding that the risk of the stenosis returning was about 40 percent. Cheney's chest pain, or angina, was due to the restenosis.
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