Wiki Heart Cath and Stent

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NESmith

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Please tell me if this supports these procedure codes. 93458-2659 & 92980RC.
Findings: Left Main: Left main coronary artery is normal
Left Anterior Descending Artery: Left anterior descending artery is moderate size vessel with minor luminal irregularities. First diagonal branch has 40% to 50% narrowing.
Left Circumflex: The left circumflex artery is a small vessel, markedly tortuous consistent with hypertensive heart disease. there is 70% stenosis in second obtuse marginal branch.
Right Coronary Artery: Rt Coronary artery is a medium size vessel. It is markedly tortuous. There is 99% stenosis in the mid portion.
Left Ventriculography: Lt ventriculography was performed in 30-degree RAO projection. Overall ejection fraction is estimated 60%.
Coronary Artery Intervention: After diagnostic procedire was performed 6-French extra backup RCA catheters were introduced in ostium rt coronary artery disease with marked tortuosity. The lesion was crossed with Whisper wire. Pre-dilatations were performed with 2.5 x 15 mm balloon. Subsequently a 2.5 x 14 mm Integrity stent was deployed at 15 atmospheres, subsequently postdilated with a 2.75 x 12 mm Sprinter ballon at 20 atmospheres, leaving 0% residual stenosis. During the procedure, intracoronary nitroglycerin was injected to multiple severe coronary spasms.
Conclusion:
1. Two-vessel disease
2. Normal lt ventricular ejection fraction.
3. Successful stenting of the culprit vessel.
Thanking you in advance for your help in this matter.
 
Based on this documentation, the only thing you can bill is the stent. It should be RC as the provider crossed the ostium of the right coronary.
 
You cannot do a left ventriculography without crossing the aortic valve. To do a left heart cath, you must cross that aortic valve so with the wording of the report - indicating a left ventriculography - that would constitute the diagnostic cath.

Now if a cath was done days prior - for example a cath done and a lesion identified and then subsequently go back days later for a stent - no cath can be charged at the time of the stent. But if you are doing the left heart cath and a lesion is identified - you can charge both. 93458-26-59 since it is a distinct separate procedure and then the 92980-RC for the stent in the right coronary artery.

I double checked with one of our interventional cardiologists just to make sure before answering you but he said if you do a left ventriculography, you are crossing the aortic valve and that constitutes a left heart cath.

Hope this helps.

Janet Gryder, CPC, CCC
Blount Heart Consultants
 
You are correct but also need the initial cath placement. How did the catheter get to the left ventricle? Was it a brachial or femoral approach? Did the catheters enter the coronaries?

Based on this documentation, I would send it back to my providers and ask questions.
 
My understanding was you code the final destination - not the initial beginning or the route. The LHC code emcompasses the access - or at least that is my understanding. Since the stent was placed in the RCA, the coronaries would have been cathed.
I agree that you should go back to the provider and make sure this is what was done.
Janet
 
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