Ask Dr. Z

Hi Dr. Z. Besides 93458, can we bill 92920-74 (hospital) for the attempted intervention? The doctor spent 35 minutes on the attempt, no balloons, just wires and microcatheter. “I used a 6 French EBU 3.75 guide catheter and selectively engaged the left main. I then attempted to cross into the 1st diagonal (culprit vessel) which is a small caliber that is less than 2 mm in diameter with a 95% stenosis and reduced TIMI 2 flow. The 1st diagonal branch has an extremely angulated takeoff. Essentially it goes backward 180° and then turns another 180° in an S shaped with extreme acute angulation that makes wiring essentially impossible. I could not wire with a run-through. I attempted wiring with a different wire she is a choice PT floppy wire crossed into the proximal diagonal but with an S shaped that prevented it from further advancing across the lesion (any time I would advance it it would flop back into the LAD). After a prolonged attempt I elected not to proceed ...” Thanks in advance!