- Messages
- 75
- Best answers
- 0
was wondering if left heart cath and additional arterial access is billable as 93458(26) and 36120 , dr clearly documented reason for additional access, would a modifier be needed also? thanks so much for your help!! i pasted portion of report below:
1. Left heart catheterization
2. Left ventriculogram.
3. Coronary angiography.
4. Additional arterial access.
CLINICAL HISTORY:
The patient is a 78-year-old male with episodic chest discomfort
underwent stress testing demonstrating moderate inferior perfusion
defect. Initially cardiac catheterization was attempted from a
radial approach. However, due to spasm in the radial artery were
unable to pass the catheter above the elbow and had to abandon the
radial approach for a femoral approach.
PROCEDURE IN DETAIL:
After obtaining informed consent, the patient was transported to
the cardiac catheterization suite where he was he was prepped and
draped in a sterile fashion. Lidocaine 2% was used to infiltrate
the skin and subcutaneous tissue overlying the right radial
artery. Percutaneous access was obtained utilizing the Seldinger
technique and a micropuncture kit with placement of a #5 French
sheath. An Allen's test had been performed demonstrating adequate
collateral circulation. We advanced a J-wire into the radial
artery but met resistance likely due to redundancy of the radial
artery. I therefore exchanged the J-wire for Wholey wire. With
the Wholey wire I was easily able to advance the wire into the
subclavian artery, however, upon advancing my catheter over the
wire there was significant resistance at the level of the elbow.
This was likely secondary to redundancy of the radial artery or
radial loop that had been straightened by the wire. At this time
we abandoned this approach and percutaneous access was then
obtained in the right common femoral artery utilizing the
Seldinger technique and a 6-French sheath was placed. I used a
6-French pigtail catheter across aortic valve and perform RAO
ventriculogram. I used a JL-4 for left coronary angiography and a
JR-4 for right coronary angiography. A StarClose was deployed in
the right common femoral artery with adequate achievement ........
1. Left heart catheterization
2. Left ventriculogram.
3. Coronary angiography.
4. Additional arterial access.
CLINICAL HISTORY:
The patient is a 78-year-old male with episodic chest discomfort
underwent stress testing demonstrating moderate inferior perfusion
defect. Initially cardiac catheterization was attempted from a
radial approach. However, due to spasm in the radial artery were
unable to pass the catheter above the elbow and had to abandon the
radial approach for a femoral approach.
PROCEDURE IN DETAIL:
After obtaining informed consent, the patient was transported to
the cardiac catheterization suite where he was he was prepped and
draped in a sterile fashion. Lidocaine 2% was used to infiltrate
the skin and subcutaneous tissue overlying the right radial
artery. Percutaneous access was obtained utilizing the Seldinger
technique and a micropuncture kit with placement of a #5 French
sheath. An Allen's test had been performed demonstrating adequate
collateral circulation. We advanced a J-wire into the radial
artery but met resistance likely due to redundancy of the radial
artery. I therefore exchanged the J-wire for Wholey wire. With
the Wholey wire I was easily able to advance the wire into the
subclavian artery, however, upon advancing my catheter over the
wire there was significant resistance at the level of the elbow.
This was likely secondary to redundancy of the radial artery or
radial loop that had been straightened by the wire. At this time
we abandoned this approach and percutaneous access was then
obtained in the right common femoral artery utilizing the
Seldinger technique and a 6-French sheath was placed. I used a
6-French pigtail catheter across aortic valve and perform RAO
ventriculogram. I used a JL-4 for left coronary angiography and a
JR-4 for right coronary angiography. A StarClose was deployed in
the right common femoral artery with adequate achievement ........