AHA Coding Clinic® for HCPCS - 2015 Issue 3; ASK THE EDITOR

Unsuccessful closure of VSD

Patient with ventricular septal defect (VSD) presents for closure of the defect. A right and left heart catheterization, as well as a left ventricular angiogram, were performed. The defect measured approximately 8-9 mm. A 5 mm Amplatzer vascular plug was chosen for the repair. The Amplatzer plug was loaded into the catheter and placed into the septal wall of the left ventricle. However, it slid through the defect into the right ventricle. The device was retrieved and removed. The repair was attempted several more times but the defect could not be closed due to the size. Therefore, the procedure could not be successfully performed. Do we code the VSD closure with or without modifier 74, or would we just code the heart catheterization? ...

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