Ask Dr. Z

How should we report CPT code +93567 when we have no documentation for a base code. Pt has Marfan syndrome with thoracic aortic aneurysm between 6 and 7 cm in diameter. He was admitted to evaluate his coronary anatomy as part of a preoperative evaluation because he has developed severe aortic regurgitation. After discussion with the cardiothoracic surgeon, it was decided the best way to evaluate his anatomy prior to surgery is to do an aortic root study which would show the origin of the left and right coronary arteries relative to the plane of the aortic root annulus and location of the tubular graft that was placed at age 13 (valve sparing aortic root replacement). Procedure: percutaneous right femoral arterial insertion of a 6F sheath after routine prep and drape and lidocaine anesthesia. Aortic root study in the LAO position with slight cranial adjustment to visualize aortic root structures including coronary arteries. At the conclusion of the study the patient left the cardiac catheterization lab in good condition with adequate right groin hemostasis and intact distal pulses. Results: aortic root pressure 101/57 mmHg. Aortogram: shows the sinuses of Valsalva are moderately dilated. The origin of the lt coronary artery is clearly seen as originating from the native sinus. The origin of the rt. coronary artery is similarly seen as to originate from the native sinus. The suture line of the aortic root graft is also clearly discernible by invaginations just above the sinuses of Valsalva. Diagnostic impression: significant aortin insufficiency. Visualization of the relative positions of the origins of the left and right coronary arteries from the sinuses of Valsalva. Based on this documentation, I would consider this service to be non-billable. Your thoughts? Claire Shumate, RHIT, CCS, CPC Washington University Medical School St. Louis