Ask Dr. Z

The cardiologist coded this as atrial septostomy (92992), which can't be right. Except for transseptal puncture nothing else is the same. The report reads more like percutaneous LVAD, but not quite. The patient was on ECMO from the day before. According to this report, transseptal puncture was to place a venous cannula and connect it to the ECMO circuit. So would this be reported with codes 36822, 93453, and 93462 if the report says only right heart catheterization was done? Dx 425.4 

"The RFV was accessed percutaneously. A 10 French sheath was placed in the vein. Right heart catheterization was performed without incident. Cardiac output was determined using FICK method. A 7 French adult transseptal sheath was advanced to the SVC. A transseptal needle was introduced, and the sheath was brought down along the atrial septum. The needle was used to puncture the septum, and the sheath was advanced across the septum. An Amplatz superstiff wire was positioned in the left atrium. The long sheath was exchanged for a 17 French ECMO cannula with the tip and drainage holes in the left atrium. The ECMO cannula was sutured into place."