by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC
Question:
Patient had PA, PWCP, AO, and LV pressures. I think 93458 for the LV and AO pressures and then one of these add-on codes for the pulmonary piece: 93568, 93569, 93573, or 93574. Thoughts?
“Coronary angiography was performed. We then did the right heart catheterization and performed cardiac output in triplicate by thermodilution method. We then also did left ventricular end-diastolic pressure along with pulmonary capillary wedge pressure to calculate the mitral valve area and a 6-French Angio-Seal was deployed at the right femoral artery and D-stat pad was used to do the closure in the femoral vein. The right coronary artery shortly after its origin has diffuse disease to the mid-vessel stenosis maximum of about 40% proximal, and about 20% mid. The ascending root is mildly dilated, aortic valve area 1.1cm2 capillary wedge pressure was approximately 18 to 20 mmHg, pulmonary artery pressure 48/26. Initial left ventricular pressure 183/21 mmHg. Left ventricular end-diastolic pressure 26. 40 mm, peak to peak gradient across the aortic valve max gradient 50 mmHg.”
Answer:
Since they also did a right heart cath with cardiac output, I would report as a right and left heart cath with coronaries with 93460. I do not see pulmonary angiography, so no 93568/93569 or 93573. It sounds like an aortic root may have been done (findings, but not for sure), which would be 93567 if documented in the full report.
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