Case -T6-1B OFFICE SERVICES

Question

Case -T6-1B OFFICE SERVICES

Examlex · Accepted Answer

The Answer is Directions to Students: A patient with the chief complaint of chest pains undergoes a
cardiac catheterization with stenting and a follow-up x-ray. Code these services.
Professional Services: 93458-26 (Catheterization, Cardiac, Left Heart, with
Ventriculography)
ICD-10-CM DX: I25.10 (Arteriosclerosis/arteriosclerotic, coronary)
Explanation: The report indicates the physician performed a left heart catheterization. The physician next injected the coronary arteries and then imaged, interpreted, and reported on the angiography. The physician then performed an injection into the left ventricle for ventriculography. The physician then imaged, interpreted, and reported on the angiography. All components of the cardiac catheterization (placement, injection, and imaging) are reported with 93458. Modifier -26 is appended to indicate the professional portion of the service. The repositioning of the catheter into the left ventricle is not reported separately, as the notes following the catheterization codes indicate that repositioning of the catheters is part of the initial catheterization service.
In the conclusion section of the report, the more definitive diagnosis of ". . . atherosclerotic heart disease." was stated. This diagnosis (I25.10) is reported rather than the symptom of chest pain (R07.9).
REPORT
The highlighted areas indicate key elements in the report:
1. HEMODYNAMICS: The left ventricular pressure before the LV-gram was 117/1 with an LVEDP of 4. After the LV-gram, it was 111/4 with an LVEDP of 10. The aortic pressure on pullback was 111/17.
2. LEFT VENTRICULOGRAPHY: The left ventriculography showed that the left ventricle was normal in size. There were no significant segmental wall motion abnormalities. The overall left ventricular systolic function was normal, at better than 60%. (THIS IS THE INJECTION AND THE INTERPRETATION.)
3. SELECTIVE CORONARY ANGIOGRAPHY: (THIS PORTION OF THE SERVICE IS THE INJECTION AND THE INTERPRETATION.)
A. RIGHT CORONARY ARTERY: The right coronary artery is a medium- to large-size dominant artery that has about 80% to 90% proximal/mid eccentric stenosis. The rest of the artery has only mild surface irregularities. The PDA and the posterolateral branches are small in size and have only mild surface irregularities.
B. LEFT MAIN CORONARY ARTERY: The left main coronary artery has mild distal narrowing.
C. LEFT CIRCUMFLEX ARTERY: The left circumflex artery was a medium-size nondominant artery. It gave rise to a very high first obtuse marginal/intermedius, which was a bifurcating medium-size artery that has only mild surface irregularities. The second obtuse marginal was also a medium-size artery at about 20% to 30% proximal narrowing. After that second obtuse marginal, the circumflex artery was a small-size artery that has about 20% to 30% narrowing, a small aneurysmal segment. After that, it continued as a small third obtuse marginal that has mild atherosclerotic disease.
D. LEFT ANTERIOR DESCENDING CORONARY ARTERY: The left anterior descending artery was a medium-size artery that is mildly calcified. It gave rise to a very tiny first diagonal that has mild diffuse atherosclerotic disease. Right at the origin of the second diagonal, the LAD has about 30% narrowing. The rest of the artery was free of significant obstructive disease. The second diagonal was also a small-caliber artery that has no significant obstructive disease.

Case -T6-1B OFFICE SERVICES

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Case -T6-1B OFFICE SERVICES

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