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Our provider suspected the patient had a PFO and proceeded to do a closure. However, during the procedure, the patient was found not to have a PFO and thus, there was no closure done. The only procedure performed was the intracardiac echocardiography, 93662. Since this is an add on code, I am struggling to code this. Any advice would be greatly appreciated. The report reads as follows:
INDICATIONS:
1. Prior cerebrovascular accident.
2. Possible patent foramen ovale.
PROCEDURES PERFORMED: Intracardiac echocardiography.
DESCRIPTION OF PROCEDURE: Informed consent was obtained. The patient was
brought to the cardiac procedure room for an intracardiac echocardiogram,
possible PFO closure. The right and left groin were prepped and draped in
sterile fashion. Lidocaine was infused in the subcutaneous tissue of the right
groin. Access was then obtained of the right common femoral vein with a
21-gauge micropuncture needle. An 8 -French 11 cm sheath was then advanced into
the right common femoral vein without difficulty. Lidocaine was infused in the
subcutaneous tissue of the left groin for anesthesia. Access was obtained of
the left common femoral vein with a 21-gauge micropuncture needle. The
micropuncture sheath was upsized to a 9-French 11 cm sheath to allow for
intracardiac echocardiography from the left groin.
The AcuNav intracardiac echocardiogram catheter was then advanced into the
right atrium and direct visualization of the interatrial septum was performed
in multiple views. The patient had 2 bubble studies and 2 distinct views of the
interatrial septum. This was with and without Valsalva and showed no evidence
of interatrial shunting.
The interatrial septum was aneurysmal but as noted before, no shunting was
documented. A 0.035 inch x 260 cm Amplatz Super Stiff J-wire was then used to
probe the interatrial septum and there was no evidence of interatrial
communication allowing for crossing of the wire. At that time secondary to the
negative bubble study x4 along with the inability to cross any defect, the
procedure was aborted.
COMPLICATIONS: None.
CONCLUSIONS:
1. Intracardiac echocardiography along with bubble study x4 with and without
Valsalva with no evidence PFO.
2. Probing of the interatrial septum with no evidence of defect as well.
RECOMMENDATIONS: We will let the patient go home today. She will need to stay
on Eliquis as she does not have interatrial shunt contributing to her CVA risk.
Our provider suspected the patient had a PFO and proceeded to do a closure. However, during the procedure, the patient was found not to have a PFO and thus, there was no closure done. The only procedure performed was the intracardiac echocardiography, 93662. Since this is an add on code, I am struggling to code this. Any advice would be greatly appreciated. The report reads as follows:
INDICATIONS:
1. Prior cerebrovascular accident.
2. Possible patent foramen ovale.
PROCEDURES PERFORMED: Intracardiac echocardiography.
DESCRIPTION OF PROCEDURE: Informed consent was obtained. The patient was
brought to the cardiac procedure room for an intracardiac echocardiogram,
possible PFO closure. The right and left groin were prepped and draped in
sterile fashion. Lidocaine was infused in the subcutaneous tissue of the right
groin. Access was then obtained of the right common femoral vein with a
21-gauge micropuncture needle. An 8 -French 11 cm sheath was then advanced into
the right common femoral vein without difficulty. Lidocaine was infused in the
subcutaneous tissue of the left groin for anesthesia. Access was obtained of
the left common femoral vein with a 21-gauge micropuncture needle. The
micropuncture sheath was upsized to a 9-French 11 cm sheath to allow for
intracardiac echocardiography from the left groin.
The AcuNav intracardiac echocardiogram catheter was then advanced into the
right atrium and direct visualization of the interatrial septum was performed
in multiple views. The patient had 2 bubble studies and 2 distinct views of the
interatrial septum. This was with and without Valsalva and showed no evidence
of interatrial shunting.
The interatrial septum was aneurysmal but as noted before, no shunting was
documented. A 0.035 inch x 260 cm Amplatz Super Stiff J-wire was then used to
probe the interatrial septum and there was no evidence of interatrial
communication allowing for crossing of the wire. At that time secondary to the
negative bubble study x4 along with the inability to cross any defect, the
procedure was aborted.
COMPLICATIONS: None.
CONCLUSIONS:
1. Intracardiac echocardiography along with bubble study x4 with and without
Valsalva with no evidence PFO.
2. Probing of the interatrial septum with no evidence of defect as well.
RECOMMENDATIONS: We will let the patient go home today. She will need to stay
on Eliquis as she does not have interatrial shunt contributing to her CVA risk.