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Thanks for your help/code suggestions!
PROCEDURES:
1. Right heart catheterization.
2. Pulmonary angiography.
3. EKOS catheter to the left pulmonary artery.
4. EKOS catheter to the right pulmonary artery.
APPROACH:
Right common femoral vein x2.
INDICATIONS:
Large bilateral pulmonary emboli.
The risks and benefits of right heart catheterization and EKOS catheter
placement were discussed with the patient. She is agreeable to the
procedure. Consent was obtained.
PROCEDURE IN DETAIL:
The patient was prepped and draped in the normal fashion. Ultrasound
was used to visualize the right common femoral vein. With ultrasound
guidance, the common femoral vein was accessed and a 6-French sheath
was introduced x2.
Right heart catheterization was performed using a 6-French balloon-tipped
PA catheter. The mean RA pressure 10 mmHg, RV 43/5 and PA pressure
44/14 mmHg. The mean pulmonary artery pressure is 26 mmHg. Pulmonary
angiogram showed the catheter in good placement.
The Swan-Ganz catheter was exchanged over a guidewire. An EKOS catheter
was placed in the right and left pulmonary artery. TPA infusion at
1 mg/hour was initiated while in
the cath lab. EKOS catheters were sutured in place. The patient was
transferred back to the intensive care unit in stable condition.
Left heart cath is performed with ultrasound guidance to gain artery access. Is there a cpt code that can be billed for the ultrasound guidance with 93458?
Thanks,
Kayla
Codes
92986
99152
76937-26
93542-26
PROCEDURES PERFORMED:
1. Aortic balloon valvuloplasty x3 across the aortic valve.
2. A 12-French side-arm sheath was placed in right femoral arteriotomy with
Perclose device. At the end of the case, Percloses were performed as well as
manual pressure given some bleeding.
3. Moderate sedation.
4. Ultrasound for vascular access.
5. Supervision and interpretation of above.
6. Left heart catheterization.
7. Left ventriculogram.
INDICATION:
The patient is an 85-year-old, Caucasian male with recent worsening shortness
of breath, pleural effusions with severe paradoxical calcific aortic stenosis
as well as multivessel coronary artery disease. I was asked by Dr. Joseph Quan
for further evaluation for balloon valvuloplasty with likely transcatheter
aortic valve replacement in the future. Informed and witnessed signed consent
was placed in the patient’s medical record. The patient understood the risk,
benefits, alternatives to balloon valvuloplasty and likely stents with Dr.
xxxxx and myself, wished to proceed with procedure. Risks include, but
are not limited to stroke, myocardial infarction, renal failure, bleeding, limb
loss, aortic insufficiency, and death.
DESCRIPTION OF PROCEDURE:
The patient was brought to the cardiac catheterization laboratory in the
fasting state. Both groins were prepped and draped in sterile fashion.
Because of Angio-Seal and prior cardiac catheterization by Dr. xxxx on
the right, we went into the left femoral artery using modified Seldinger
technique, ultrasound and micropuncture kit. With a 6-French sheath in place,
Perclose sutures were affixed. Next, upsized to a 12-French side-arm sheath.
There was some calcium noted, however, was able to place a 12-French side-arm
sheath into the femoral artery. Next, with the Amplatz AL1 and straight wire,
we were able to cross across the valve and pressures were measured with pigtail
catheter. Next, left ventriculogram was also performed. Next, I proceeded
with placement with an Amplatz extra stiff wire into the left ventricle.
Balloon valvuloplasty was performed with a Bard true flow balloon at 20 mm up
to compliant pressure x3 across the aortic valve. Pigtail catheter on pullback
showed no changing gradient suggesting successful balloon valvuloplasty. Next,
continue with the rotablation part of the procedure. Please see Dr. xxxx note. In addition, prior to balloon valvoplasty, a pacemaker device was
placed using modified Seldinger technique and ultrasound with sheath access in
the right femoral vein and a balloon tipped pacemaker placed in the right
ventricle wire.
RESULTS:
1. Successful balloon valvoplasty x3 across the aortic valve with no gradient
at the end of the case.
2. Proceeded with coronary stent placement.
RECOMMENDATIONS:
1. The patient will have staged procedure with CSI atherectomy and balloon
angioplasty and stent placement on November 20th and will come back likely in
mid December for transcatheter aortic valve replacement when all the workup is
complete for that.
2. Groin precautions x1 week. Bed rest for at least 10 hours with Femstop in
left femoral artery.
I have found the below documentation from the 2010 ICD-9 Coding Clinic that states if a pacemaker is placed to treat the sick sinus syndrome, that only the pacemaker code should be used. I am not able to find any documentation that shows this has changed. Would this only occur during the interrogation? Would you be able to bill both codes out at a regular follow-up visit?
Would a complete heart block fall into the same situation? I am not able to find any official documentation to confirm if the complete heart block and pacemaker codes can be used together.
Not billing the complete heart block would affect the patient’s risk score just as with the sick sinus syndrome.
Any and all help is greatly appreciated!
Thank you – Missy
ICD-9-CM Coding Clinic, Third Quarter 2010 Pages: 9-10 Effective with discharges: October 1, 2010
Question:
Coding Clinic, Fifth Issue 1993, page 12, advised that when sick sinus syndrome (SSS) is controlled by a pacemaker, no code assignment is required if no attention or treatment is provided to the condition or the device. However, we are seeing records where the patient is admitted for an unrelated condition, but during the stay the physician does an interrogation of the pacemaker. Is it appropriate to assign a code for sick sinus syndrome, as a chronic condition, when a patient has a previously placed pacemaker and it is interrogated during the hospitalization?
Answer:
Assign code V53.31, Fitting and adjustment of other device, Cardiac device, cardiac pacemaker, as an additional code assignment. A code is not assigned for sick sinus syndrome when it is being controlled by the pacemaker and no problems are detected during the check. Interrogation is a routine check, which is done via computer to assess pacemaker function. The pacemaker is routinely evaluated to ensure the device is programmed accurately as well as to assess battery and lead function. Pacemaker settings may be reprogrammed, if required. Interrogation of the device can be done in the inpatient setting or in the office setting.
Code 89.45, Artificial pacemaker rate check, may be assigned for the procedure.
I am new to cardiology and trying to get these concepts down.
Patient had a Left Heart Cath done, access obtained through the right femoral artery. Doctor dictates then that a "Right femoral arteriogram was performed, then a right femoral arteriogram with runoff to the foot was performed."
What codes do I use for this? I think he is duplicating his dictation?