Ask Dr. Z

Any guidance on annual cath/biopsy for transplant patients... does this documentation support medical necessity? Using Z48.21, Z94.1 for ICD-10 codes.

"PROCEDURES PERFORMED: Selective coronary angio, LHC, RHC, US-guided access of the left axillary vein, IVUS LAD and LMCA, right ventricular endomyocardial biopsy.

HISTORY: Male with a history of stage D non-ischemic cardiomyopathy. The patient underwent BTT-H VAT. He had a very complicated and prolonged postoperative course. He developed right ventricular failure. He required prolonged temporary right ventricular mechanical circulatory support. He required LVAD pump exchange. He ultimately recovered and underwent cardiac transplantation in December 2019. Patient has a history of HTN, type 2 DM and HLD he presents today for his annual invasive transplant evaluation.

CONCLUSIONS: ISH LT CAV 0, intravascular ultrasound demonstrates stable donor derived atherosclerosis, low right and left heart filling pressures, normal cardiac index, normal pulmonary pressures, successful right ventricular endomyocardial biopsy."