HIT 251 CODING PRACTICUM (MEDICINE SECTION ENCOUNTERS) What are the CPT and ICD-
ID: 305702 • Letter: H
Question
HIT 251 CODING PRACTICUM (MEDICINE SECTION ENCOUNTERS)
What are the CPT and ICD-10-CM codes?
CARDIAC CATHETERIZATION DATE OF PROCEDURE: 11/28/20XX PHYSICIAN: Dr. Smith
REFERRING PHYSICIAN: Dr. JOnes PROCEDURES PERFORMED: Left Heart Catheterization; right and left coronary artery angiography; left ventriculography; saphenous vein graft/stub injection _ 3
TECHNIQUE: The patient’s right groin was sterilely prepped and draped and anesthetized with 2% lidocaine. A French introducer was placed in the right femoral artery.The JL4 and JR4 catheters were used for selective angiography of the left and right coronary arteries respectively.The JR4 catheter was then manipulated to cannulate the saphenous vein graft to the right coronary artery.The LCB catheter was then used for selective angiography for the saphenous vein graft to obtuse marginal branch #2 and #3.The pigtail catheter was advanced to the aortic valve and manipulated into the ventricle. Left ventricular pressures were recorded and left ventriculography performed. The patient tolerated the procedure well.
COMPLICATIONS: None.
HEMODYNAMIC FINDINGS: Left ventricular pressure 127/24, aortic pressure 127/55 with a mean of 82. Heart rate 66 beats per minute. Body surface area 1.65 meters sq. ANGIOGRAPHIC FINDINGS: LEFT MAIN CORONARY ARTERY: The left main coronary artery originates normally in the left sinus of Valsalva. It is a short medium size vessel and is free of disease.
LEFT ANTERIOR DESCENDING ARTERY: The left anterior descending artery courses normally in the interventricular groove. It gives rise to two small trivial diagonal branches. The left anterior descending demonstrates a 40% proximal eccentric lesion.
CIRCUMFLEX CORONARY ARTERY: The circumflex coronary artery courses normally in the atrioventricular groove and then is totally occluded after the second obtuse marginal artery.The first obtuse marginal artery is a small trivial vessel. The second obtuse marginal artery is diffusely diseased in its proximal to mid segment with lesions ranging from 20% to 80%.
RIGHT CORONARY ARTERY: The right coronary artery is totally occluded in its proximal segment.
SAPHENOUS VEIN GRAFT TO RIGHT CORONARY ARTERY: The saphenous vein graft to the right coronary artery is widely patent with good runoff into the native vessel. Medicine 006 Native right coronary artery is noted to be small. No progression of atherosclerotic disease is seen.
SAPHENOUS VEIN GRAFT TO OBTUSE MARGINAL BRANCH #2: The saphenous vein graft to obtuse marginal branch #2 is totally occluded and the stub remains. SAPHENOUS VEIN GRAFT TO OBTUSE MARGINAL BRANCH #3: The saphenous vein graft to obtuse marginal branch #3 demonstrates luminal irregularities throughout its course. Lesions ranging from 10% to 30%.Distal anastomotic site is widely patent. Native vessel is fee of disease.
LEFT VENTRICULOGRAPHY: Left ventriculogram demonstrates normal left ventricular size.The diaphragmatic wall is akinetic. The inferobasal wall is severely hypokinetic. Systolic function is moderately reduced with ejection fraction of 40%.Mild mitral insufficiency is present. No evidence of mitral valve prolapse.
CONCLUSIONS: 1. Severe two vessel coronary artery disease involving the right coronary artery and circumflex 2. Moderate disease involving the native left anterior descending 3. Saphenous vein graft to the right coronary artery is widely patent 4. Saphenous vein graft to obtuse marginal branch #3 demonstrates nonhemodynamically significant lesions. Adequate flow is noted 5. Saphenous vein graft to obtuse marginal branch #2 is totally occluded in its proximal segment 6. Normal systolic pressure 7. Elevated left ventricular diastolic pressure 8. Moderately reduced systolic function
RECOMMENDATIONS:Will have catheterization film evaluated for possible PCI of the obtuse marginal branch #2 vessel and continue aggressive cardiac risk factor modification.
Explanation / Answer
1 CPT Code 93459 if the Left heart catheterization (wit or without left ventriculogrphy),Coronary angiography ,and bypass graft ,angiography.
2 CPT code 33512 as saphenous vein graft is used in the coronary arteries.
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