Jane5711
Networker
Hi,
I have been getting requests for Medical Records from a particular insurance company (not Medicare) in regard to "Surgical/Procedure code". I'm getting a bit nervous that I have not coded these procedures correctly. Please see one below and advise.
I'm extremely worried........
PROCEDURES PERFORMED:
1. Orbital atherectomy of the mid left anterior descending artery using
1.25 mm Diamondback CSI atherectomy device at 80,000 RPMs.
2. Angioplasty and stent of the mid left anterior descending artery with
a 2.5/23 mm Xience Alpine Everolimus drug-eluting stent.
3. Percutaneous transluminal coronary angioplasty and stent of the mid
left circumflex artery using a 2.25/28 mm Xience Alpine Everolimus
drug-eluting stent.
INDICATIONS:
1. Angina pectoris.
2. Coronary artery disease with a history of 75 to 80 percent calcific
stenosis of mid left anterior descending artery and 80 percent
stenosis of the mid portion of the left circumflex artery.
3. Coronary artery disease.
4. Angina pectoris.
5. History of ischemic heart disease.
PROCEDURE: After the informed consent was obtained, the patient was
prepped and draped in the usual sterile fashion. Lidocaine 2 percent was
used for local anesthesia in the right groin. Vascular access was obtained
in the right femoral artery, and over a guidewire, a 6-French angiographic
sheath was placed in the right femoral artery.
A 6-French XB 3.5 guide without side holes was used to engage the left
coronary artery.
A 0.014 Viper wire was used to cross the lesion in the mid left anterior
descending artery. A 1.25 mm orbital atherectomy Diamondback CSI device
was advanced in the mid LAD and was used to do the atherectomy of the left
anterior descending artery to 80,000 RPMs for 3 runs. The atherectomy
device was removed.
Then, a 2.5/20 mm balloon was advanced through the guidewire and used to
dilate the lesion in the mid LAD at 12 atmospheres. The balloon was then
removed.
Then, a 2.5/23 mm Xience Alpine Everolimus drug-eluting stent was advanced
into the mid LAD and was deployed at 12 atmospheres with good results. The
stent balloon was removed and angiographic images obtained and then the
_____ was changed.
The atherectomy device and the guidewire removed.
Then, a 0.014 Asahi Sion blue wire was used to cross the lesion in the mid
left portion of the left circumflex artery. A 2.25/25 mm balloon was
advanced over the guidewire into the mid left circumflex artery used to
dilate the lesion at 12 atmospheres. Balloon was then removed and then a
2.25/28 mm Xience Alpine Everolimus drug-eluting stent was advanced in the
mid portion of the left circumflex artery and was deployed at 12
atmospheres with excellent results. The stent balloon was removed. Final
angiographic images were obtained. The guidewire and guiding catheter were
removed. Arterial sheath was sutured in place and the patient was
transferred in a stable condition to the floor for further care with no
complications.
RESULTS:
1. Prior to the procedure, there was a 75 to 80 percent calcific stenosis
of mid left anterior descending artery.
2. Prior to the procedure, there was 80 percent stenosis of the mid
portion of the left circumflex artery.
3. Post-procedure after atherectomy followed by angioplasty and stent of
the mid left anterior descending with a 2.5/23 mm Xience Alpine
Everolimus drug-eluting stent, there is 0 percent residual stenosis
with no dissection, no thrombosis and distal TIMI-3 flow.
4. Post-procedure after angioplasty and stent of the mid portion of the
left circumflex artery with a 2.25/28 mm Xience Everolimus
drug-eluting stent, there is 0 percent stenosis of the mid left
circumflex artery with no dissection, no thrombosis and distal TIMI-3
flow.
PLAN:
1. Arterial sheath will be removed later today.
2. Renal function will be monitored.
3. Maximal medical treatment of coronary artery disease to continue with
the patient who will remain on dual antiplatelet agents.
I coded:
92933 - LD - atherectomy
92928 - LC - PTCA
99152 - sedation
I'm not sure which code is not correct!!!!
PLEASE HELP!!!!!!!!
Jane in distress, CPC
I have been getting requests for Medical Records from a particular insurance company (not Medicare) in regard to "Surgical/Procedure code". I'm getting a bit nervous that I have not coded these procedures correctly. Please see one below and advise.
I'm extremely worried........
PROCEDURES PERFORMED:
1. Orbital atherectomy of the mid left anterior descending artery using
1.25 mm Diamondback CSI atherectomy device at 80,000 RPMs.
2. Angioplasty and stent of the mid left anterior descending artery with
a 2.5/23 mm Xience Alpine Everolimus drug-eluting stent.
3. Percutaneous transluminal coronary angioplasty and stent of the mid
left circumflex artery using a 2.25/28 mm Xience Alpine Everolimus
drug-eluting stent.
INDICATIONS:
1. Angina pectoris.
2. Coronary artery disease with a history of 75 to 80 percent calcific
stenosis of mid left anterior descending artery and 80 percent
stenosis of the mid portion of the left circumflex artery.
3. Coronary artery disease.
4. Angina pectoris.
5. History of ischemic heart disease.
PROCEDURE: After the informed consent was obtained, the patient was
prepped and draped in the usual sterile fashion. Lidocaine 2 percent was
used for local anesthesia in the right groin. Vascular access was obtained
in the right femoral artery, and over a guidewire, a 6-French angiographic
sheath was placed in the right femoral artery.
A 6-French XB 3.5 guide without side holes was used to engage the left
coronary artery.
A 0.014 Viper wire was used to cross the lesion in the mid left anterior
descending artery. A 1.25 mm orbital atherectomy Diamondback CSI device
was advanced in the mid LAD and was used to do the atherectomy of the left
anterior descending artery to 80,000 RPMs for 3 runs. The atherectomy
device was removed.
Then, a 2.5/20 mm balloon was advanced through the guidewire and used to
dilate the lesion in the mid LAD at 12 atmospheres. The balloon was then
removed.
Then, a 2.5/23 mm Xience Alpine Everolimus drug-eluting stent was advanced
into the mid LAD and was deployed at 12 atmospheres with good results. The
stent balloon was removed and angiographic images obtained and then the
_____ was changed.
The atherectomy device and the guidewire removed.
Then, a 0.014 Asahi Sion blue wire was used to cross the lesion in the mid
left portion of the left circumflex artery. A 2.25/25 mm balloon was
advanced over the guidewire into the mid left circumflex artery used to
dilate the lesion at 12 atmospheres. Balloon was then removed and then a
2.25/28 mm Xience Alpine Everolimus drug-eluting stent was advanced in the
mid portion of the left circumflex artery and was deployed at 12
atmospheres with excellent results. The stent balloon was removed. Final
angiographic images were obtained. The guidewire and guiding catheter were
removed. Arterial sheath was sutured in place and the patient was
transferred in a stable condition to the floor for further care with no
complications.
RESULTS:
1. Prior to the procedure, there was a 75 to 80 percent calcific stenosis
of mid left anterior descending artery.
2. Prior to the procedure, there was 80 percent stenosis of the mid
portion of the left circumflex artery.
3. Post-procedure after atherectomy followed by angioplasty and stent of
the mid left anterior descending with a 2.5/23 mm Xience Alpine
Everolimus drug-eluting stent, there is 0 percent residual stenosis
with no dissection, no thrombosis and distal TIMI-3 flow.
4. Post-procedure after angioplasty and stent of the mid portion of the
left circumflex artery with a 2.25/28 mm Xience Everolimus
drug-eluting stent, there is 0 percent stenosis of the mid left
circumflex artery with no dissection, no thrombosis and distal TIMI-3
flow.
PLAN:
1. Arterial sheath will be removed later today.
2. Renal function will be monitored.
3. Maximal medical treatment of coronary artery disease to continue with
the patient who will remain on dual antiplatelet agents.
I coded:
92933 - LD - atherectomy
92928 - LC - PTCA
99152 - sedation
I'm not sure which code is not correct!!!!
PLEASE HELP!!!!!!!!
Jane in distress, CPC