Ask Dr. Z

Would you accept the following documentation to support billing 93458? The LVEDP was measured, but no documentation by the provider of actually entering the left heart to do this. My understanding is that the LVEDP can also be measured indirectly via PCWP measurement from pulmonary artery (I don't think that's what's occurring here, but think it's worthy of a query to clarify catheter placement). Please let me know thoughts.

"...Access was obtained in the right radial artery and 5/6F slender sheath was placed. Left ventricular end diastolic pressure was measured using a 5F Tiger 4.0 catheter. Coronary angiography was performed using 5F Tiger 4.0 catheters and multiple cineangiographic views were obtained. Coronary angiography showed severe 90% mid LAD stenosis, which was the culprit lesion. A 6 French EBU 3.5 guide catheter was used to engage the left main coronary artery....