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medihedgie

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I haven't done coding for LHC in two years, and am nervous about missing the basics.

Without bothering with the entire report...if the doctor says
1 Left Heart Cath
2 Selective Cor Visualization
3 Distal abdomial aorta arteriogram
am I using anything other than 93458 ?
can I /should I add 75630 or 93567 or what have you? Or is the 93458 covering those three line items?
The physician does A LOT that look more or less the same..so if I am confident of the basics, I can tweek if there is something unusual.
THANK YOU for your help!
 
LHC, Coronaries and Abdominal Aortogram

First, you must be very careful when reading Left Heart Cath and defining it as a procedure. Often times, when a patient has a cath, whether the Left Heart is selected or just the coronary arteries, staff and even physicians call it a LHC. But, unless a catheter enters the left side of the heart (ie Left Ventricle with a pigtail), it is NOT a Left Heart Cath. But, instead, Coronary Arteriography. If the Left Heart is selected (usually pressures are taken) with or without a Ventriculogram, then you can call it a Left Heart Cath. Selecting and Injecting the Coronaries will be the second part of the complete code. As for the Abdominal Arteriogram, you need to determine intent and the interpretation of the imaging. The Supravalvular Aorta would never be reported for a distal abdominal aortogram. If just the Renals were interpreted, then the code 75625-52 might be best used. Medicare allows the code G0275. If the Aorta, renals and maybe some other visceral branches, 75625 would be appropriate. If the iliac arteries were described only, then 75716 might best be used. Medicare allows the code G0278. The location of the catheter (Distal Aorta vs. Aorta at the Iliac bifurcation) plus the interpretation will guide you to the correct code. 75630 is more of a complete code for the Abdominal Aorta, its branches and the flow down the legs.

Hope this helps.
 
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It depends on the Renals. When performing LHC if the physician does a non-selective view of the renals, then you should use G0275. If, however, a selective renal cath and angio are done, then take a look at 36251-36254.

+93567 - Provided to view aortic insufficiency and aortic valve; supravalvular (ascending) aorta.

Without reading the report it's hard to say if 93567 or 75625/75630 & 75716 should be used. IMO

HTH
 
I feel like I don't have enough information on the report:
The description of the procedure is as follows:

" I attempted to use standard J wire;however there was resistance in the distal abdominal aorta.I then exchanged for Wholey wire, which seems to pass more easily. I carefully advanced a 6-French sheath over guidewire without difficulty. This slit in quite easily and this aspirated without issue. I proceeded with at JL-4 to cannulate the left main coronary artery. Multiple angiograms were taken in the RAO and LAO projections. I then used the JR-4 to cannulate the right coronary artery. Multiple angiograms were taken in the RAO and LAO projections. I then exchanged over an exchange wire an angled pigtail. The aortic valve was crossed and hemodynamic measurements were obtained. Pullback was performed without difficulty. Prior to terminating the case I did take a distal abdominal aorta arteriogram which is a hand injection."

Thank you for your response!
 
From what your report states, it looks like you have 93458 and 75625-59 (or G0275 if it's a Medicare claim). Just make sure you have an interp of the coronary arteries as well as the abdominal aorta and (at least) LV pressure measurements included in the report.

Elizabeth
 
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