Ask Dr. Z

Should the following congenital heart cath be coded 93533 and 93567? Or 93531 and 36221? Would we need more documentation of the specific vessels visualized to submit code 36221? "Patient has a history of a large VSD, a PDA, LAD coronary artery to RV fistula. A catheter was advanced to the right heart, and a pressure and saturation sweep was performed. The Wedge catheter was also advanced across the atrial septum to the left lower pulmonary vein where pressures and saturations were recorded. A careful pullback from the LV to the descending aorta was performed using a Pigtail catheter. The catheter was placed in the aorta, and two angiograms were performed in the aortic root. Aortic Root: Two angiograms via the Pigtail catheter demonstrate the aortic root and left arch with normal brachiocephalic branching pattern. Both angiograms demonstrate the coronary artery branching patterns, without specific evidence of coronary artery fistula."