Left Heart Catheterization with Selective Coronary Angiography- help

Would you code this as CPT® 93454 and 93458 or just 93458?


PROCEDURE: 20 CC of 2% lidocaine was administered to the right groin and the right femoral artery was cannulated and a 4 French sheath was inserted utilizing the Seldinger technique. Through this sheath a 4 French JL4 catheter was introduced and advanced in a retrograde fashion into the ascending aortic root. The guide wire was removed, and the aortic pressure was recorded. The catheter was then advanced in a retrograde fashion into the ostia of the LM coronary artery. Selective coronary angiography was performed in multiple obliquities, and the catheter was then removed and exchanged for a 4 French JR4 catheter which was similarly advanced in a retrograde fashion into the ascending aortic root. The guide wire was removed, and the aortic pressure was recorded and the catheter was then manipulated into the ostia of the RCA. Selective coronary angiography was then performed in multiple obliquities, and the catheter was removed and exchanged for a 4 French pigtail catheter. The pigtail catheter was advanced in a retrograde fashion into the ascending aortic root. Once again the guide wire was removed, and the aortic pressure was recorded. The catheter was then advanced retrograde across the AV and positioned in a stable position in the body of the LV. LV pressures were recorded, and an LV gram was performed. Post angiographicLV pressures were recorded and the catheter was then withdrawn with simultaneous monitoring of the AO pressure. Final pressures were recorded, and the catheter was then removed followed by subsequent removal of the sheath in the cath lab. Hemostasis was then achieved with direct local compression. The patient tolerated the procedure well and left the cath lab in a stable condition, in good spirits with no chest pain or EKG changes.


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