Cardiology Coding Alert

Let our experts show you the PV ropes If coding heart catheterizations - particularly procedures that include peripheral vascular (PV) interventions - sends you into cardiac arrest, a few minutes brushing up on the basics could be just what you need to improve your cath coding acumen.

Take a look at the following left heart cath procedure with percutaneous transluminal angioplasty (PTA) and review our experts' coding recommendations: 1. Procedure Overview: See What Was Done Here's a quick service synopsis: A 60-year-old male patient with peripheral vascular disease (443.9) had a left heart catheterization with left ventriculography. The physician performed selective left and right coronary angiography, selective left and right carotid and renal angiography, an abdominal aortogram, and right iliac angiography.

The physician also performed a PTA to eliminate a blockage in the right anterior tibial artery. 2. Operative Note: Trace the Cath Placement, PTA The pertinent details from the operative note follow:

The physician inserted a 5-French sheath into the left femoral artery and used diagnostic JL4 and JR4 diagnostic catheters to obtain selective left and right coronary cinean-giograms in multiple projections. He also used the JR4 catheter to obtain selective cineangiograms of the left and right carotid arteries and the renal arteries. He used a pigtail catheter to cross the aortic valve and obtained measurements, followed by a left ventriculogram. He calculated a pullback gradient across the aortic valve. He then brought the pigtail catheter into the abdominal aorta and performed an abdominal aortogram. Due to sub-optimal visualization of the distal leg arterial system, he advanced the catheter past the aortic bifurcation using the pigtail catheter and performed a selective cineangiogram of the right iliac artery. The physician identified a lesion in the right anterior tibial artery. He advanced a multipurpose guiding catheter over the wire down to the distal right superficial femoral artery (SFA). He performed cineangiograms, which confirmed the target. He advanced a balloon dilation catheter over a 0.14 guidewire through a guiding catheter down to popliteal artery. 3. Coding Advice: Follow These 6 Steps Now, you're ready to tackle the coding. Our experts offer these six steps for breaking down the procedure. 1. Fill in the holes. You probably noticed that this operative note has some missing information. So if you were coding this, you'd need to get all the details down before you start, experts say.

In this situation, you should begin by asking the cardiologist to clear up any confusion about whether he performed both a left heart cath with left ventriculography and left and right coronary angiography, says Judy Allen, CPC, compliance privacy officer for Birmingham Radiology Group in Birmingham, Ala.

Also, find out if the carotid arteries the physician identifies are [...]