This page addresses follow-up questions and additional information pertinent to our webinar Considering Cardiac Caths.
The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.

Q:  Out of curiosity, in a coronary artery bypass graft, where would the stenosis or occlusion be in relation to where the graft is attached?
A:  Since blood is flowing from the aorta to the coronary artery, when a bypass is performed, the graft is attached downstream from the occlusion to allow for reperfusion of the artery.

Q: In CPT, coronary thrombectomy can only be coded when it is removed using mechanical techniques. Is this the same for PCS?
A: No, this guideline does not apply to ICD-10-PCS. In thrombectomy, the intent is to remove solid matter (clot) and the method of removal is not a consideration.

Q: In case study 1 from the webinar, you sequenced the drug-eluting stent code first. Why did you choose that sequencing?
A: The ICD-10-PCS Official Guidelines for Coding and Reporting noted in section F state that the procedure performed for definitive treatment of both principal diagnosis and secondary diagnosis should be sequenced first as the principal procedure. In this case, the patient presented with an ST-elevation myocardial infarction (STEMI) and he underwent diagnostic cardiac catheterization, coronary angiography, angioplasty, thrombectomy, placement of a drug-eluting stent, and placement of an Impella heart assist device. All of these procedures could arguably have been related to the STEMI, but it was the angioplasty, thrombectomy, and drug-eluting stent procedures that were most closely related to the principal diagnosis of STEMI. We chose to sequence the drug-eluting stent placement code first according to this guideline.

Q: A patient is transferred from another facility with an Impella in place and it is removed at this facility. How is this coded?
A: Coding Clinic, 4th Quarter 2016, page 137 addresses this topic. Codes for Insertion and Assistance may be reported by the facility that placed the Impella device. The receiving facility does not report an Assistance code. If the receiving facility removed the Impella device, a code for Removal may be assigned.

Q: Which medical record documentation is indicative of a diagnostic cardiac catheterization?
A: For a left heart cath, look for documentation of left ventricular (LV) pressures, left ventricular end diastolic pressure (LVEDP), or ejection fraction. For right heart cath, look for documentation of blood sampling and pulmonary artery or wedge pressures. Remember that the sixth character for function in the Measurement table is “Sampling and Pressure.” Documentation should reflect that blood sampling was done and/or blood pressures were taken. It is also worth noting that in PCS guideline A10, the term “and,” when used in a code description, means “and/or.” Even if blood sampling was not done, the fact that pressures were is enough for code assignment.

Q: Which body part value from the Fluoroscopy table is used to report left and right coronary angiography? Is it Heart, Right and Left, or Coronary Arteries, Multiple?
A: The body part for left and right coronary angiography is Coronary Arteries, Multiple. The body parts Heart, Left; Heart, Right; and Heart, Right and Left are used to report imaging of the heart chambers (e.g., left ventriculography) rather than the coronary arteries that provide oxygen to the heart muscle.