amym
Guest
Physician turned in charges for an FFR only and we billed 93571-26. Since 93571-26 is an add on code and cannot be billed by itself what else can we bill based on the following note? Is CPT 93454-26 appropriate?
PROCEDURES PERFORMED:
-- Right coronary angiography.
-- Left coronary angiography.
-- QR - Hemostasis with Mynx.
-- Interventional Flow Wire.
CORONARY VESSELS: The coronary circulation is right dominant. Proximal
LAD: There was a 50 % stenosis.
FFR performed showing >0.9 being no significant lesion Circumflex: Normal.
Distal RCA: There was a 0 % stenosis at the site of a prior stent.
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.
-- 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.
-- 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.
-- QR - Hemostasis with Mynx..
CARDIAC INTERVENTIONS
-- Interventional Flow Wire.
COMPLICATIONS:
There were no adverse outcomes.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
Test started at 13:27. Test concluded at 13:57. RADIATION EXPOSURE:
Fluoroscopy time: 3.4 min.
MEDICATIONS GIVEN:
Midazolam, 1 mg, IV, at 13:27.
Adenosine (Adenocard), 10 mcg, intracoronary, at 13:44.
Heparin, 5000 units, IV, last dose at 13:40.
1% Lidocaine, 10 ml, subcutaneously, at 13:29.
CONTRAST GIVEN:
Omnipaque 35 ml.
STUDY DIAGRAM
Angiographic findings
Native coronary lesions:
7Proximal LAD: Lesion 1: 50 % stenosis.
7Distal RCA: Lesion 1: 0 % stenosis, site of prior stent.
HEMODYNAMIC TABLES
Outputs: Baseline
Outputs: -- CALCULATIONS: Age in years: 56.64
Outputs: -- CALCULATIONS: Body Surface Area: 1.95
Outputs: -- CALCULATIONS: Height in cm: 170.00
Outputs: -- CALCULATIONS: Sex: Female
Outputs: -- CALCULATIONS: Weight in kg: 83.90
DICTATED BY: 34363
PROCEDURES PERFORMED:
-- Right coronary angiography.
-- Left coronary angiography.
-- QR - Hemostasis with Mynx.
-- Interventional Flow Wire.
CORONARY VESSELS: The coronary circulation is right dominant. Proximal
LAD: There was a 50 % stenosis.
FFR performed showing >0.9 being no significant lesion Circumflex: Normal.
Distal RCA: There was a 0 % stenosis at the site of a prior stent.
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.
-- 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.
-- 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.
-- QR - Hemostasis with Mynx..
CARDIAC INTERVENTIONS
-- Interventional Flow Wire.
COMPLICATIONS:
There were no adverse outcomes.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
Test started at 13:27. Test concluded at 13:57. RADIATION EXPOSURE:
Fluoroscopy time: 3.4 min.
MEDICATIONS GIVEN:
Midazolam, 1 mg, IV, at 13:27.
Adenosine (Adenocard), 10 mcg, intracoronary, at 13:44.
Heparin, 5000 units, IV, last dose at 13:40.
1% Lidocaine, 10 ml, subcutaneously, at 13:29.
CONTRAST GIVEN:
Omnipaque 35 ml.
STUDY DIAGRAM
Angiographic findings
Native coronary lesions:
7Proximal LAD: Lesion 1: 50 % stenosis.
7Distal RCA: Lesion 1: 0 % stenosis, site of prior stent.
HEMODYNAMIC TABLES
Outputs: Baseline
Outputs: -- CALCULATIONS: Age in years: 56.64
Outputs: -- CALCULATIONS: Body Surface Area: 1.95
Outputs: -- CALCULATIONS: Height in cm: 170.00
Outputs: -- CALCULATIONS: Sex: Female
Outputs: -- CALCULATIONS: Weight in kg: 83.90
DICTATED BY: 34363