Cardiology Coding Alert

Question: According to the documentation, the patient’s left ventricular pressure was 5 mmHg, and the aortic pressure was 137/65 mmHg. The right coronary artery was 100% occluded at the ostium, and the distal vessel was filling via left-to-right collaterals. The left main was angiographically normal. The left anterior descending was a medium to large caliber vessel with ostial 60 to 70% stenosis, mild to moderate diffuse mid-vessel disease, and patent distal segment. This was identified as a type III wraparound LAD. The LAD was providing collaterals to distal RCA. Diagonal 1 was a small to medium caliber vessel with ostial 50% stenosis, patent mid to distal segment. Diagonal 2 was a small caliber vessel that appeared angiographically normal. The left circumflex was 100% occluded at the ostium. Sluggish flow was noted into the obtuse marginal one branch, which seemed to be the culprit vessel for the acute myocardial infarction. The left subclavian selective angiography revealed patent left subclavian artery and IMA. The cardiologist performed a left ventriculogram by entering the left ventricular cavity, using a 5-French JR4 diagnostic catheter, and LVEDP was measured at 5 mmHg. The patient was then transferred to the recovery area in stable condition. The cardiologist confirmed multivessel CAD, hypertension, dyslipidemia, Type 2 diabetes mellitus, CKD, and NSTEMI. They recommended that the patient receive CT surgery evaluation for CABG. How should I report this?

Maine Subscriber

Answer: You should report 93459 (Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography).

Don’t miss: The left subclavian/IMA is bundled into 93459.