foreign [Music] hey we've got a great night for you guys tonight live with CCO this is when we get to have a more casual conversation of course these also are questions that you guys have submitted and want us to kind of unpack for you uh I always enjoy the topics that you send in this particular topic has to do with the heart and I always love talking about the disease process and how everything works within the heart today uh the the question we picked is coding congenital heart catheterizations now why is this important though one thing that you need to know is just recently in the last couple years the codes have changed there were some deleted codes back in the day for uh congenital heart catheterizations and because of that they tweaked a little bit how uh that's to be coded be very very careful when you go and look at online um answers to congenital heart catheterizations because even if it's a reputable Source because again the codes changed I believe in 22 so again we're not talking about that long ago and because of that it'll look like that you've got the right information always check within your encoder I'm a big fan of find a code that's what we use at CCO and it popped up right away to alert me to let me know that hey these codes were updated and to give you further research so again even if it's a vetted and reputable site that you're doing your research with with pay very close attention to the dates and then always double check the information against other sources to make sure that something hasn't been outdated now if you're on top of the new codes that come out every year you probably already flagged this that it's that there has been a significant change in the coding of catheterizations and specifically when dealing with uh congenital heart anomalies or defects and stuff so I encourage you to every year when the new codes drop that you pay attention make notes of those changes and in fact if there's been changes in a specific area like one year it was really heavy with changes on uh procedures to the ears and eyes and I I don't the reason that struck me as interesting is because those are codes that don't change very often but they had and it was both in CPT and ICD which again that was relevant and so I actually put a note over my monitor and listed the major areas in ICD that there were significant changes in the codes most of the time that's like like laterality we're going to be talking about CPT codes today however since my passion and Specialty is an ICD I I stay on top of it as much as possible so I would encourage you to do that whenever you notice changes in the in the new coding year that it'll just make note of it somewhere where you can keep reference and pretty soon it'll be stuck in your mind uh again congenital heart catheterizations that I believe changed in 22 and in fact I can even double check that real quick real quick I'll just double check yeah it was 12 31 of 2021 the codes for this area the 93530 code and then that code range changed and now it's 935-93 and nine four so important to stay on top of that that's just a little tip hopefully that will help you be a faster and more accurate code or hi Stephanie and Andrea I just saw your names pop up great to see you always nice to know where you guys are uh uh coming in so pop where you're from as you guys remember I used to be in Texas and I'm in Missouri now right let's talk uh real quickly about the code range for cardiac catheterizations the code range uh is CPT codes nine three four five four and nine three four five five they're billed only once per catheterization and the CPT codes for cardiac catheterizations include the dye injections for the Angi angiogram and Catherine replacement repositioning and the supervision and interpretation so if you're looking to see where this was located at in your manual what you're going to be looking at is cardiac catheterization procedures and then you're going to be looking at catheter placement and coronary artery for coronary angiographs including intra procedural injections for coronary angiograph so that was going to be at the top of your May manual it feels like I went too fast let's oh okay good and uh hi guys there I see where you guys are coming in from Pennsylvania um uh Mississippi and uh oh where's that Massachusetts New York of course and Kentucky and Arkansas great guys thanks for sharing where you guys oh Houston Texas I was just talking to somebody from Houston today Jill's coming out of Ohio great guys great great great all right now uh the key here is that um it's actually two separate categories for coding for people that have congenital It's A congenital uh catheterization versus a uh one where there is no heart anomaly okay so uh we would call that maybe like two different families congenital heart disease and then everything else now we know that that's pretty common right whenever you have somebody that has a diagnosis and uh it you've got a code for it however if they were born that way that's a cue code something completely different uh therefore that makes us understand the CPT codes could follow the same thought process the uh because they want to track these are people that have heart anomalies these are people that have heart anomalies and they were born that way don't forget I'm always saying this again and again we code for statistical purposes it happens to be a convenient way to get paid so to statistically we are separating people that have these heart conditions and people that have these heart conditions because they were born that way and then we're doing these procedures and we're able to track the congenital catheterizations versus the non all right now that we've looked at this let's go to the next code range if we go look at 93593 and that should be through 93597 not and I'll get that corrected in the slide deck it can be billed When A congenital heart defect is identified now how do we find that in the CPT manual we're still going to cardiac catheterization procedures but the next level that you're going to be looking at is that cardiac catheterization for congenital heart defects and then it goes into the the subcategory that it's catheterization for the congenital heart Defector defects including Imaging guidance for the procedure to advance the catheter to the Target Zone notice the difference guys this is what we're looking at here where we have the catheter placement and it also includes the angiography the intra procedural injections for the coronary angiography however here we're looking at it includes the Imaging and um the procedural list to advance to the Target Zone that verbiage is different that means that we need to read the full code description whenever we see a header that is um is different okay we're going to look at this code range 93593-93597 so what makes them different what signifies the difference between each one of these individual codes and what you need to know when you're abstracting the documentation from the documentation to code to the highest specificity uh now I've just kind of demonstrated here what the bat technique is for us and we would uh put this in a bubble so you look at your codes 93593 in your manual and you would bubble around 93597 okay and put that all in a bubble that's the bat technique that Laureen created back in 1999 we're gonna bubble then we're gonna highlight everything that's after the semicolon because that's what distinguishes the difference in these code is what's after the semicolon so highlight that you know I think it's best to stick with one color and use uh yellow or whatever color you're going to use throughout your manual if you're not familiar with the bat technique this will allow you to want again code quicker and it will make you more accurate now we always want to shave time off our coding it's quality and quantity for us um so if there is going to be especially areas that are intense with things like procedures done on the heart then anytime you can shave a little bit of time by saying okay these are the codes that we have bubbled that are for congenital cardiac caths versus the other ones so this has got their own little bubble right here so now we know that we have to abstract because of what is highlighted whether it's normal native connection or if it's an abnormal native connection that's what distinguishes um these options in the code the first takeaway one well I guess for the first one in this bubble of congenital so we have to know that it's congenital defect and then we have to say okay is it the normal native connection or an abnormal native con connection next what do we need to know well they can do a right heart cath and they can do a left heart cath and they can do a right and left heart cath that's the second thing you need to abstract from the documentation are we dealing with a right the procedures all done on the right is or is it done on the left or is it the right and left now I could and I'm surprised that I didn't but I love the anatomy of the heart and to be able to tell you why would they do a right heart cath and why would they do a left heart or why would they need to do both I didn't do that this time so I would encourage you to go do your research and so that you better understand the procedures themselves and why they would do that their significance between why they go in and do right side and why they go in and do left and why they would have to do both okay if you know that already going in and part of the the procedures that are associated with the disease process again that'll make you a factor and um more accurate coder so I I love to do that but I did not do that this time you can do that research on your own and then after you've done that research this would be a really good idea for you to share with your team members if you don't already do that maybe you guys have Team meetings or different organizations call them different things you have a little quirky or fun names but this a little bit of research and feel free to use this content because we are keeping this up our CCO live stay up on the channel the YouTube channel and of course you get all of that extra stuff for when we do the um if you're on the CCO Club you will understand uh these codes and then you can share that with your team and not only will they think you're brilliant but it helps you become a better coder when you start presenting that being said before we go on to the rest of the content for tonight wanted to do a little advertisement uh you guys may or may not realize this but we don't we don't advertise for the most part uh what we do is shared via Word of Mouth uh from peer-to-peer and our our students of course and we wanted to let you know that we have a CCO Club at cco.us forward slash club that allows you to see content that we don't keep up on the website and we don't keep up on the social media sites we will give teasers and but a lot of these this content is placed out in our CCO club and not only do you get the content a live version of us talking together you also get a transcript of the video you get the slide deck as well and then you can wash it at your leisure anytime and go back and reference it so there's a lot of advantages of having the CCO Club but even with all all of um those bonuses the additional aspect that I think is and I have a lot of fun with because it's even more connection with my peers is that you can submit questions and then we can have discussions there it's a it's an area that you can have basic questions asked and you may want to pop in and and answer some of that stuff because you have been in the industry a little longer than another person so it feels good to be able to do that and share your wisdom but then there are also some pretty Advanced questions that happen with scenarios that are unique out in the real world as we call it that kind of broadens your focus maybe it's a specialty that you're not familiar with and then you see everybody come in and discuss it and provide resources so again it's a valuable place to be able to get some excellent content and their CEUs in there great for that little tidbit of advertisement moving on let's now talk about what is actually involved in these cardiac catheterizations if they do a right heart catheterization for the congenital anomaly the cardiac anomaly uh uh let's let's talk about the process how they they do it now I didn't go into why they do right why they do last okay but the process of how it's done and the reason this is going to be pertinent for you is because this is what it looks like representation and we want to be able to get very um good at abstracting quickly so they go in they numb the area and they get it all ready okay they prep uh I took that out we don't we didn't necessarily need to know that that's basic knowledge but they take a guide wire and they're gonna feed that through the femoral vein if you are not as familiar with the anatomy of the vascular system take some time to brush up your knowledge but the femoral vein or they could do uh well most of the time in these particular scenarios they go up through the femoral vein and then it goes into the external iliac vein and we're just moving up so femoral vein is kind of right there at the the midsection between the leg and the hip right the groin area and they make a little incision uh you know not too awful big but we are tapping a major vessel and so people after they have these procedures done don't get to get up and move around it used to be a lot longer of a wait time back in the day when I worked at the hospital it could be several hours uh significant hours like five hours but then they came up with this new type of a glue device that they'd kind of plug the hole up and it could just be like a couple hours honestly I don't know how long it is now maybe it's so Advanced that that it's less than an hour but you had to lay flat back in the day and and you were monitored by the nurses so we started the femoral vein we move up um to the external iliac vein then we go into the inferior vena cava so we are just moving up the backwards normally we would talk about these and go from the heart and go down but this is backwards and then we go into the right atrium again we're coming down into the right atrium then they take the catheter and once it's inserted into the brain the vein and it's threaded over the guide wire into the inferior vena cava the catheter is then passed into the right atrium the right ventricle and into the pulmonary arteries so again they put the guide wire in they get it placed where they want to go and then they take that catheter and they feed that up through the guide wire uh gosh I guess if I had a straw I could show you that I should have thought of that man I can't believe I didn't think of that is to get a straw and then take one of my really fine crochet uh Hooks and show you how they would place that that this was with guide wire and it's like feeding a straw over that guide wire the where it needs to go then once the catheter is uh being passed through the right side of the heart and into the pulmonary arteries the right heart chambers are all looked at so they they give it a good look and the congenital anomaly is evaluated so we need to know how severe is the uh anomaly uh where is it specifically located and is there any um part of uh is there any other detriment to to that anatomy of the heart because of that anomaly that kind of just giving it the old hairy eyeball I guess you could say now uh let's see uh blood pressure in the right atrium and The ventricle are obtained if you did know that they could do that pretty cool pretty pretty cool guys that they do this um for a lot of reasons but they want to know the struggle the heart's having and uh I uh my mother-in-law I guess you wouldn't care if I shared that with you I'm always talking about my family she just got diagnosed with pulmonary hypertension so she's gonna go in and they have their Echo and everything so she's getting ready to go to the cardiologist and of course I get to go with her thrilling she knows that I would love to to do that but one of the things they do sometimes is they'll do do these type of procedures and then they'll go in and measure that pulmonary artery to get the pressures so they can do that as well they're able to obtain the pressures of the right atrium and The ventricle fascinating isn't it so then they look at the oxygen levels how much oxygen is getting um passed through there and then the tricuspid valve and the pulmonary valves they're all looked at are these anomalies involved in the valves or are they being affected due to uh the anomaly in the heart and they uh just kind of track everything that's happening in the pathways of the heart and they make note of all of that in their documentation for for what they're seeing now they also do a angiogram and that's a separate report of the right heart chambers and the pulmonary arteries in all in that so when you read these reports for a cardiac catheterization there is a lot going on um it if you if you wanted I would think and I don't know we used to be able to obtain the these um there's been so many advances though I don't know back in the day I've said that more than once now that's starting to age me you could go to transcription sites people that practice track transcription and you can see documentation for these procedures I would encourage you to go do that and then see how these um reports are worded it's going to be very very similar to what we're showing showing here and and therefore that's one of the advantages now we're not done so we've done all the measuring and everything so the the procedure itself is complete they're going to take out the catheter their the compression is applied to the venous site where they went in the femoral vein and they put it uh addressing now in cardiac anomalies the sub pulmonary ventral ventricle and Atrium may be a morphological left ventricle or Atrium but the catheter placement is still considered right white heart catheter that's very very important to note do not get that confused okay so if they do a right heart catheterization not a less heart catheterization but they see that the anomaly is on the left but they still they did a right heart catheterization that's what you're coding for okay um the cut let's see let me make sure I get all this right the connections of cardiac Chambers and great vessels are important for diagnosing the congenital heart disease and the three segments are generally considered you've got the Atria to the systemic and pulmonary veins the arterial ventricle valve connections and the great arteries outflow tracks now that means don't forget the great vessels are considered the aorta and the aorters divided up you've got the aortic Arch you've got the uh descending and you've got the veins you've got the vena cava the inferior of the superior vena cava where these those are considered great vessels all right um now oh Carmen says I'm curious what would you consider a good production for Siege decoding um uh uh you know I'm not sure I could find out however think about this if you're doing cardiac caths um it's pretty straightforward there's not a lot of codes involved we saw just for the congenital codes how many codes there were and how many codes there were for the regular cats now I didn't break those up because our topic was congenital um you can do a lot of these it's um just a few codes everything's kind of involved right it's not like you have to go out and do oh they did this and they did this and this and I got to add it to it um so Carmen I would say that it would be quite a few in an hour now uh keeping in mind that when you specialize sometimes they if your contract sometimes they pay you by hour but sometimes they pay you by report or encounter and so if you're new and this is this is new for you you want to do it by in counter or report because then you don't have to feel like you're a burden and then as you get better and faster it goes uh very quickly and you make more money now if you're seasoned and uh then you could say well I want to be paid by the hour and I can do x per hour that can be expected so uh I guess it's a better way of thinking about it is how many can one provider do in a day and how many providers are doing them so are you working for a facility or are you working for a cardiac center so common it's an excellent question I don't have the answer for it but I have access to people who do know what the averages are in fact I would encourage you to check in with Stacy Buck because she is a Circ specialist she educates in cert and I think she would have the pulse you know what I did there on what averages were for different type of cardiac Cardiology coding so Stacy Buck she has a great site uh off uh gosh I think it's called rat RX I'm not sure what her we've interviewed her before and uh we use her as a resource pretty often so um check in check one with her all right where did I leave off guys so um they check for the normal connections and allow for the blood flow um uh and stuff the way let's see from the vena cava to the right atrium then the right ventricle and the pulmonary arteries and if you have normal connections uh and everything and and there's include asynonic defects meaning they're not cyanotic they're getting good blood flow with a good oxygen such as uh arterial or ventricular septical septal defects or patent ductus arterias abnormal connections Force the blood flow through alternate Pathways and result in cyanotic defects which cyanotic is the um the lack of blood flow you know think blue right we're not getting oxygenated um it's not oxygenated blood so a cyanotic is without cyanotic Newton not cyanotic and uh so we look for not defects such as a double Outlet right ventricle or an endocardial cushion defect or um the tetralogy of filet Fallout filet uh total and anomalous pulmonary veins and trans position of great vessels that's really a neat thing about the anatomy now you're going to report 93593 for normal native connections remember and 93594 for the presence of abnormal connections that's a takeaway that I would make a note of and I noticed that um Jesus put up Stacy's link so Carmen you might check in at her her site again she specializes in Circ not just Cardiology coding but I think she would she would be able to give you a good reference on those now that last point right so 93593 for normal native connections and nine three five nine four for the presence of abnormal connections huh I would I would uh put that in your manual next to those codes so um when we look at um the code 93598 that is cardiac output measurements and it's a thermal modulation of other indicator dilation methane performed during cardiac catheterization for the evaluation of the congenital heart defect and you list separately any of the additional codes in the primary but note you can use 93598 with 935934 etc etc so this is not in the bubble right 93598 is a cardiac output measurement that is not part of that bubble that we just talked about now you code it in conjunction with our bubble okay if they do these cardiac output measurements so don't bubble that in there and when you look at the manual you can see they're indented and this this code is there but it's right there off to the side now uh what do we do with indicator dilation studies that go directly to the code that we just looked at what is that what makes that separate and Carmen good I'm glad that feedback helps you and um oh you are already a circle fabulous so so good thanks that you know um you even took a course good good well then uh you passed the Circ and again we'll we'll do a little research and and see maybe somebody if they know later we can put that on the the bottom of the comments in the chat or it'll be in the club somebody will make that point so check back Carmen and let us let us know that you found the answer or or we can find the answer so we're we're backtracking back to the indicator dilation studies to that code that was not in the bubble so with cardiac output measurements whenever they do that to evaluate that intra cardiac um shunts and valvular regurgitation is what they're looking for again this is um this is part a very common part of the process that they do that so the cardiac output is actually the measurement of how much blood is being pumped into the systemic circulation uh per minute so how much blood are we getting through the body per minute and I mean that's that's your your blood pressure but but we're looking at the pressures in the in the the organ itself not systemic um per se where well actually we're doing books systemically you just take your blood pressure with a blood pressure cuff right but we're wanting to see with these indicator dilation studies what's happening in the heart so the procedure differs slightly depending on whether a Dye or a thermal dilution is used um for the dilation studies using the dye the Venus and arterial catheters are inserted and then a blood sample is obtained and they actually do it the centimeter and uh it's calibrated using the concentration for the dye and with the blood sample and that dye is injected into the catheterizated the catheterized vein now what happens is this dye that gets mixed in with the blood it circulates all the way through the heart and then it's pumped out systemically throughout the body and then that blood sample is obtained from um the artery that has the catheterization running through it and then that meter is used to analyze the measure and the amount of the dye present in the sample and then um uh in retrospect that machine can calculate cardiac output but that's not all so uh the indicator dilation study when they do that they if they use a cold thermal dilation they use a swan Gans catheter and it's inserted through the internal jugular or subclavian vein in the right atrium The ventricle and then the tip is Advanced into the branch of the pulmonary artery now if you guys have never seen these Swan gases put in is pretty amazing there's a lot of reasons for them to do that but actually a swan gants is this uh think of it is is a IV uh on steroids so you get uh you know like a regular IV that you would put into somebody's arm and this thing has extra projections in it so that you can put in multiple stuff at once so you have multiple bags going uh there's reasons the the way I got to see them being used was trauma working in the ER and they would go and and do it like this cut down type thing and they would place them and it was usually only done if uh well the times that I saw it being done in the ER was massive trauma and um usually it was pretty straightforward to get those in and sometimes it was not so um there's a little bit of skill involved to put them in it is not something that they want to put in I don't think and I could be wrong when a person is conscious um the few times that I saw it it was fifty percent they were conscious fifty percent they weren't and they were getting them transferred uh getting them stabilized to transfer to the university and they wanted to at least get that put in and um so um but know that they'll go up into the major the karate or the jugular internal jugular uh not the Carotid Arty internal jugular is what we're talking about here and that subco clavian vein and there's a subclavian artery so when you're doing these cardiac catheterizations um for for this we're doing uh veins not arteries all right so again different reasons to have them done there's different types of catheters Swan gants is one time and uh don't uh you can go out and look at what a swan gants catheter looks like it's been a long time since I've seen one but they've other all other little nuances but do you guys remember oh gosh I keep thinking back in the day uh remember when we used to call everything a Jacuzzi well not everything's a Jacuzzi that's a name brand they're hot tubs but jacuzzi is a brand of hot tub well that's kind of way it is with the swan Gans there's multiple types of these different you know specific catheters and and what they're used for but a swan Gans is a specific type okay now that I've digressed sorry so the what they do is they take that cold dextrose that's injected into the port of the Swan gas catheter and lies in the right atrium it's sitting there and then the dextrose immense cold and it mixes with the blood of the right atrium and then The ventricle and then it passes into the pulmonary artery where that temperature drop is sensed by that that meter and at the tip of the catheter lying in the pulmonary artery so cardiac output is actually calculated using the temperature time curve so again the warmth of the body your blood is a certain you know temperature and now my brain just went out to having wounds in a cold day and steam and stuff that's really odd in it don't backtrack okay so uh your body is internal you know when you take your temperature it's 98.6 but internally it's higher than that and so when they cool that dextrose solution and it's heavy and it shoots in through to where they're wanting to monitor it's measuring the temperature at that one spot so when that cold hits it it alerts and it can stay from the time that you inject and it starts to the time that it hits that tells you how much output you got and really interesting so it'll gives you a temperature time curve yeah and then the indicator dilution studies using warm thermal dilution they take the swans against catheter with a heating coil and it's introduced into the right heart as the same thing they do with the cold and a series of heat pulses or administrating signal analysis is used to calculate cardiac output and then these cardiac output measures are done in conjunction with the primary primary catheterization and then they get a proper diagnose of the congenital cardiac Anomaly by being able to do that so they visualize it they can monitor pressures and then they can also do further investigation and these are diagnostic studies not screenings diagnostic studies to learn more about the anomaly that's involved okay guys I hope this was helpful to you and if it was let us know this is just a clip of the fascinating stuff that happens with Carson catheterizations they the cardiac catheterizations you can also do further research on the different types of catheterizations again our rad RX is Stacy Buck's site that she specializes in the Circ and um this is a I don't want to say this is a niche this is a specialty of coding cardiac and Interventional Radiology that maybe is fascinating to you it's there's not a vast number of codes that you're dealing with even the diagnosis codes are you know there's not a whole lot of them that you're dealing with so if this is something now I'm not talking about Interventional Radiology I'm talking about these catheterizations don't get that confused Interventional Radiology oh that's a different ball game it is more complex but this little bit of catheterization type thing for these anomalies that I'm looking at that's that's not as difficult and uh you will probably find that if you get involved with it it's repetitious and uh once you get that under your belt uh just like Carmen said you know how many can you do in an hour probably quite a few uh these are you know get in and uh Monitor and look at what you're doing and get out um so I I encourage you that if this fascinates you that you look into doing some more you can find some great mentors out there to help you obviously Carmen just uh that she or not Jess but she passed the Circ but just cardiac Cardiology is is a fun area to be in it should not be intimidating because it's really mostly just based on the anatomy at heart and you've got that uh under your belt pretty quickly once you learn the the laterality of it and the the basic names if you are interested in giving us a topic and us talking through it and unpacking it like we did tonight uh feel free to submit a topic request and thank you Stephanie we really appreciate it and Kim uh that that this was helpful um those requests all you have to do is go to cco.us forward slash topic topic hyphen request you you feed us you you feed our passion of sharing knowledge uh about this industry and in doing so by submitting requests then we know what your needs are and that's the important thing we can do the research we can teach you how to do the research so that you can also in turn share that with others put a little take away here is you do some extra research and then turn around and share that with Team what you've learned it's it's good for you and if you think oh I don't think I can do that push push those comfort zone thinks outside the box consider speaking to your local chapters on uh topics like this uh you you know feel free to use the content that we offer to you free on the channel or uh to help you with your studies as you look to work on presentations share the knowledge all right guys thank you very much for joining us tonight I know you understand that we enjoy what we do learning is a lot of fun and we do education full-time and again when you tell us what you need uh for uh to increase your knowledge base we're out happy to provide we'll see you next time bye guys do you need more medical certification and business training learn more at www.cco.us [Music] thank you