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My physician performed an emergent cardiac catherization with multiple cardioversions exceeding 15. Am I able to bill that many cardioversions?
PROCEDURES:
1. Emergent cardiac catherization
2. Emergent temporary pacemaker placement, 5-french with balloon tipped under fluoroscopy for asystole.
3. Primary PCI PTCA to the right coronary artery in cardiogenic shock set up and multiple ventricular fibrillation, cardiac arrest with multiple cardio versions exceeding 15 times.
4. Endotracheal intubation, which was complex, but successful.
5. Intraarotic balloon pump placement for cardiogenic shock.
Indication:
1. ST elevation acute inferior STEMI
2. Cardiac arrest, asystole followed by VFIB
3. Severe hypotension
The patient was brought into the ER for acute myocardial infarction. He was severely hypotensive and Brady cardiac being prepped on the table. The patient had developed this asystole, emergent temporary pacemaker was placed. Then, a 6 French sheath was placed via right femoral artery and angiography was attempted and performed in the right coronary artery during that event and it was interrupted multiple times due to ventricular fibrillation arrest. The patient was cardioverted more than 15 times. ACLS protocol was performed. He received 150 of amiodarone, 100mg of lidocaine. finally, we were able to balloon the artery with 2-0 then within a 3-0 20 balloon and PTCA rate of the RCA and multiple levels to remove thrombus and restore flow and TIMI 0 flow at the beginning followed by TIMI 3 flow. There were 40% residue in the mid RCA and some residue of thrombus in the left ventricular branch, but with TIMI 3 flow, which was restored.
Angiography of the left coronary system afterwards was performed revealed patient left main and LAD and circumflex artery. Unfortunately, during the procedure, we had table and we had to perform the procedure on 1 angle, which is LAO and we were unable to reset the equipment till the end of the procedure. After the vessel recanalized, Intraarotic balloon pump was placed successfully via the right femoral artery and under fluoroscopic monitoring, 40mL, a balloon pump was placed and it went very well. The patient has done relatively well and the subsequently the patient appear to be stable, we withdrew the temporary pacemaker as he was maintained on rhythm, we used a 5-french sheath for the venous access and he was given dopamine, potassium, magnesium in addition to fluids.
Findings:
1. NO LV gram done though LVEDP measured, which was elevated during that time, patient was asystole, so catheter was withdrawn and no further attempt was done due to ventricular irritability.
2. Left main 50%
3. Left anterior descending artery, patent.
4. Circumflex artery, moderate size and patent.
5. Right coronary artery, heavily calcified and multiple stents and occlusion appeared to be within ostial with a proximal occlusion 100%
6. Successful PTCA of the right coronary artery, restoring TIMI 3 flow from original TIMI 0 flow and 40% residue and lesion type C.
7. Delayed PCI to primary PCI is recurrent cardiac arrest and multiple cardioversion and CPR and intubation of the patient.
Even though LVEDP measured I don't see a complete LHC here so I'm uncertain of what to code especially with 15 cardioversions.
Should I code
93454
92920 RC
33967
33210
92960
Thanks!
PROCEDURES:
1. Emergent cardiac catherization
2. Emergent temporary pacemaker placement, 5-french with balloon tipped under fluoroscopy for asystole.
3. Primary PCI PTCA to the right coronary artery in cardiogenic shock set up and multiple ventricular fibrillation, cardiac arrest with multiple cardio versions exceeding 15 times.
4. Endotracheal intubation, which was complex, but successful.
5. Intraarotic balloon pump placement for cardiogenic shock.
Indication:
1. ST elevation acute inferior STEMI
2. Cardiac arrest, asystole followed by VFIB
3. Severe hypotension
The patient was brought into the ER for acute myocardial infarction. He was severely hypotensive and Brady cardiac being prepped on the table. The patient had developed this asystole, emergent temporary pacemaker was placed. Then, a 6 French sheath was placed via right femoral artery and angiography was attempted and performed in the right coronary artery during that event and it was interrupted multiple times due to ventricular fibrillation arrest. The patient was cardioverted more than 15 times. ACLS protocol was performed. He received 150 of amiodarone, 100mg of lidocaine. finally, we were able to balloon the artery with 2-0 then within a 3-0 20 balloon and PTCA rate of the RCA and multiple levels to remove thrombus and restore flow and TIMI 0 flow at the beginning followed by TIMI 3 flow. There were 40% residue in the mid RCA and some residue of thrombus in the left ventricular branch, but with TIMI 3 flow, which was restored.
Angiography of the left coronary system afterwards was performed revealed patient left main and LAD and circumflex artery. Unfortunately, during the procedure, we had table and we had to perform the procedure on 1 angle, which is LAO and we were unable to reset the equipment till the end of the procedure. After the vessel recanalized, Intraarotic balloon pump was placed successfully via the right femoral artery and under fluoroscopic monitoring, 40mL, a balloon pump was placed and it went very well. The patient has done relatively well and the subsequently the patient appear to be stable, we withdrew the temporary pacemaker as he was maintained on rhythm, we used a 5-french sheath for the venous access and he was given dopamine, potassium, magnesium in addition to fluids.
Findings:
1. NO LV gram done though LVEDP measured, which was elevated during that time, patient was asystole, so catheter was withdrawn and no further attempt was done due to ventricular irritability.
2. Left main 50%
3. Left anterior descending artery, patent.
4. Circumflex artery, moderate size and patent.
5. Right coronary artery, heavily calcified and multiple stents and occlusion appeared to be within ostial with a proximal occlusion 100%
6. Successful PTCA of the right coronary artery, restoring TIMI 3 flow from original TIMI 0 flow and 40% residue and lesion type C.
7. Delayed PCI to primary PCI is recurrent cardiac arrest and multiple cardioversion and CPR and intubation of the patient.
Even though LVEDP measured I don't see a complete LHC here so I'm uncertain of what to code especially with 15 cardioversions.
Should I code
93454
92920 RC
33967
33210
92960
Thanks!