Ask Dr. Z

A 6-week-old girl with HLHS, interrupted aortic arch type B, and moderate VSD who is status post Norwood, modified BT shunt and DKS presents with concerns for RV dysfunction with moderate tricuspid regurgitation and LPA stenosis on last echo. She presents for diagnostic cath to rull out causes of RV dysfunction and/or possible intervention. A right and left heart cath via existing atrial septal opening (93533-26) was done. Contrast injection of the innominate artery shows a right-sided BT, which is widely patent. The RPA appears to be of good caliber. There is severe long segment stenosis of the LPA with severe hypoplasia distally with normal pulmonary venous return of the left atrium." Is the statement 'rule out causes of RV dysfunction' sufficient documentation to support medical necessity for billing the S&I for the BT shunt (75710-26)? Also, can we bill for the catheter placement in the innominate artery (36215), or would that be bundled in the pulmonary angiography code 93568?