Wiki R/L Cath - need help

[TWilliam2019]

R/L cath, coronary angiography and fluoroscopy of the AV

detail: prepped and draped in usual sterile fashion. Lidocaine was used for local anesthesia,versed for sedation. seldinger technique was used to cannulate the right femoral vein and place a 7 french venous sheath. Swan Ganz catheter was advanced to wedge position w hemodynamic monitoring performed. PA set was obtained. thermodilution cardiac outputs were performed. Subsequently Seldinger technique was used to cannulate the right femoral artery and place a 6 french arterial sheath. a dual lumen pigtail catheter was advanced to the proxiaml ascending aorta, muliptle wires were used in an attempt to cross the aortic valve. fluoroscopy showed a heavily calcified,nodular AV w a very eccentric orifice opening, the valve barely moved. Under Fluoroscopy, multiple attempts with different wires were used acroos the valve, with no success. eventually given the risk for embolism attempts were abandoned. Subsequently, JL4 and 3DRC catheters were used for selcetive coronary angiography. Following the procedure catheters and sheaths removed. No complications.


New to coding and need help
how would I code this
Thanks

 

[Jim Pawloski]

R/L cath, coronary angiography and fluoroscopy of the AV

detail: prepped and draped in usual sterile fashion. Lidocaine was used for local anesthesia,versed for sedation. seldinger technique was used to cannulate the right femoral vein and place a 7 french venous sheath. Swan Ganz catheter was advanced to wedge position w hemodynamic monitoring performed. PA set was obtained. thermodilution cardiac outputs were performed. Subsequently Seldinger technique was used to cannulate the right femoral artery and place a 6 french arterial sheath. a dual lumen pigtail catheter was advanced to the proxiaml ascending aorta, muliptle wires were used in an attempt to cross the aortic valve. fluoroscopy showed a heavily calcified,nodular AV w a very eccentric orifice opening, the valve barely moved. Under Fluoroscopy, multiple attempts with different wires were used acroos the valve, with no success. eventually given the risk for embolism attempts were abandoned. Subsequently, JL4 and 3DRC catheters were used for selcetive coronary angiography. Following the procedure catheters and sheaths removed. No complications.


New to coding and need help
how would I code this
Thanks

Since the catheter did not go into the VC, you bill Coronary Angio. w/ RHC - 93456.
HTH,
Jim Pawloski, CIRCC

 

[TWilliam2019]

R/l cath

The rest of the report is
Findings
Hemodynamics
RA 8, RV 35, PA 32/9 W a mean of 21, pulmonary capillary wedge of 15, aorta 133/63 PA sat 61%, AO sat 96% Cardiac output by thermodiution 5.57 and cardiac index 2.64 Cardiac output by Fick 4.72 and cardiac index 2.24
AV fluoroscopy notes severe nodular calcification of the AV apparatus and annulus w minimal valve leaflet opening, the valve opening is extremely eccentric.
Coronary anatomy
L main coronary is short,trifurcates is moderate in caliber w no significant disease noted.
L anterior descending is moderate vessel which courses around the apex and supplies the distal inferior wall There is a mild tubular stenosis up to 30 % in the late proximal and early midportion of the vessel w mild irregualities distally. No severe stenosis are noted. The vessel gives rise to several small diagonal branches, which have mild disease.
the ramus intermedius is large, bifurcates and has mild disease up to 30% in the midportion of the vessel but no severe stenoses
The left circumflex is codominant, is fairly large, gives rise to multiple high small marginals and then 2 moderate posterolateral branches distally and then a mdoerate posterior descending, This vessel has mild luminal irregularities only
the right coronary artery is fairly small, is codominant w a tubular 30 to 40 % proximal stenosis and then mild irregularities distallly


so with this information would you still could only the coronary and rhc

 

[Jim Pawloski]

The rest of the report is
Findings
Hemodynamics
RA 8, RV 35, PA 32/9 W a mean of 21, pulmonary capillary wedge of 15, aorta 133/63 PA sat 61%, AO sat 96% Cardiac output by thermodiution 5.57 and cardiac index 2.64 Cardiac output by Fick 4.72 and cardiac index 2.24
AV fluoroscopy notes severe nodular calcification of the AV apparatus and annulus w minimal valve leaflet opening, the valve opening is extremely eccentric.
Coronary anatomy
L main coronary is short,trifurcates is moderate in caliber w no significant disease noted.
L anterior descending is moderate vessel which courses around the apex and supplies the distal inferior wall There is a mild tubular stenosis up to 30 % in the late proximal and early midportion of the vessel w mild irregualities distally. No severe stenosis are noted. The vessel gives rise to several small diagonal branches, which have mild disease.
the ramus intermedius is large, bifurcates and has mild disease up to 30% in the midportion of the vessel but no severe stenoses
The left circumflex is codominant, is fairly large, gives rise to multiple high small marginals and then 2 moderate posterolateral branches distally and then a mdoerate posterior descending, This vessel has mild luminal irregularities only
the right coronary artery is fairly small, is codominant w a tubular 30 to 40 % proximal stenosis and then mild irregularities distallly


so with this information would you still could only the coronary and rhc[/QUOTE

Since multiple wires and catheters were use, you could use modifier-52 with the RHC/LHC.
good luck with it,
Jim