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Janice Posted Wed 13th of December, 2017 09:26:57 AM
he was prepped and draped in the routine sterile fashion after informed consent was obtained. The right groin was locally anesthetized. A JL4 was placed in the left coronary system with diffuse coronary calcification. Left main is patent. The LAD had proximal to mid eccentric 80 to 90% sequential stenosis with a contained ulcerated plaque. The diagonal had ostial 70% to 80% stenosis. Circumflex had diffuse luminal irregularities. JL4 was removed and a 3DRC was placed and the right coronary artery. The RCA had mid up to 80% stenosis and distal 30% to 40% stenosis. The 3DRC was then repositioned to the left subclavian. The LIMA is patent. Pigtail catheter was then placed in left ventricle. LVEDP 16, LV systolic pressure is 150. On pullback, the aortic pressure 148/65 with a mean of 98. The patient tolerated the procedure well and there were no complications. The sheath was removed in the cath lab with good hemostasis. IMPRESSION: 1. Left main is patent. 2. LAD with sequential proximal to mid up to 80 to 90% eccentric stenosis with a contained ulcerated plaque. The diagonal has ostial 70% to 80% bifurcating lesion. The circumflex had diffuse luminal irregularities. The RCA had mid 80%, distal 30% to 40%
SuperCoder Answered Thu 14th of December, 2017 03:47:43 AM

Hi Janice,

As per above documentation, pigtail catheter was placed in left ventricle and left ventricular end diastolic pressure is performed.

We have to code 93458 when LHC, Left ventriculography and coronary angiogram is performed. However, sometimes provider may perform coronary angiogram and just enter the left heart to measure the pressures and won't perform left ventriculography, we will code 93458 with modifier 52. This code also includes imaging supervision and interpretation, as well as any required repositioning of catheters.

Also, there was no mention of graft in document to bill 93459. Please feel free to ask for any further query.


Janice Posted Thu 14th of December, 2017 10:33:51 AM
so if he was looking at the LIMA to assess it for potential use as a bypass graft it would still be coded 93458 ??? thanks
SuperCoder Answered Fri 15th of December, 2017 03:44:25 AM

Hi Janice,

When provider says he has checked the patency of LIMA, it can be assumed that he is planning for graft. However, grafting is major procedure and to be sure of procedure being performed, we will need documentation,( LIMA taken down and prepared for bypass grafting, or bypass grafting done). If documentation confirms then we can bill 93459.  Hope it helps.


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