# Angio & stenting



## maryann1224@bellsouth.net (Feb 26, 2013)

Need some help with the new codes; since patient admitted w/ STEMI; would these codes be correct?    92941, 92928 LD, 92928 RC...Thank you for any assistance.

PROCEDURES PERFORMED                       
1.  Angioplasty and stenting of the circumflex artery.
2.  Angioplasty and stenting of the obtuse marginal vessel.
3.  Angioplasty and stenting of the LAD.
4.  Angioplasty and stenting of the right coronary artery.

CLINICAL HISTORY:
The patient is a 66-year-old male admitted with ST elevation
myocardial infarction in the setting of anemia and report of
melanic stool.  The patient had known three-vessel coronary
disease and failed medical management.  He was turned down for
open heart surgery because of high risk that patient is felt to be
a poor rehab candidate.  The patient continued to have post
infarct angina and returned for percutaneous multivessel
angioplasty.

PROCEDURE:
After obtaining informed consent, the patient was transported in
the nonsedated condition to the cardiac catheterization suite.  The
patient was prepped and draped in a sterile fashion.  Lidocaine 2%
was used to infiltrate the skin and subcutaneous tissue overlying
the right common femoral artery.  A #6 French introducer sheath
was placed in the right common femoral artery utilizing the
modified Seldinger technique.  A #6 French EBU-3.75 guide catheter
was used for the left coronary intervention.  An XB-RCA #6 French
catheter was used for the right coronary intervention.

Angiomax was administered after percutaneous access had been
obtained.  The #6 French guide was used to engage the left main
coronary artery and I advanced a BMW Elite wire into the large
first obtuse marginal vessel of the circumflex artery.  Angioplasty
was performed on a lesion that extended from the proximal
circumflex into the proximal OM1 and angioplasty was performed on
the lesion in the mid obtuse marginal vessel.  I then positioned a
3.5 x 23 mm multilink Vision bare metal stent in the distal obtuse
marginal vessel and deployed it.  A 3.0 x 12 mm Trek balloon was
used for the angioplasties on the circumflex and OM.  The stent in
the distal OM was a 3.5 x 23 mm Abbott Vision bare metal stent
deployed with two inflations to 18 atmospheres.  I then advanced a
3.5 x 15 mm Abbott Vision stent into the proximal circumflex with
it extending into the proximal OM.  This stent was deployed with
inflations to 14 atmospheres.  I returned and post dilated the
vessel with a 4.0 x 12 mm balloon.  Final angiography after
removal of balloons and wires demonstrated TIMI-3 flow with no
perforation, dissection or distal embolization.

I then turned my attention to the left anterior descending artery.
I used the same wire to advance across the LAD lesion and in the
proximal LAD performed angioplasty with a 3.0 x 12 mm Trek
balloon.  I then advanced a 3.5 x 23 mm Abbott Vision bare metal
stent into the left anterior descending artery and deployed it
with two inflations to 12 atmospheres.  I returned with a 3.5 x 15
mm stent delivery balloon to within that stent and performed high
pressure angioplasty up to 18 atmospheres.  I removed the balloons
and wires, repeated angiograms and had TIMI-3 flow with no
perforation, dissection or distal embolization.

Attention was then turned to the right coronary artery.  The right
coronary was engaged with an XB-RCA guide catheter.  The same BMW
Elite was advanced into the posterolateral branch and I used a 3.0
x 12 mm balloon for angioplasty.  I then advanced a 4.0 x 15 mm
Vision stent into the mid right coronary artery.  This was
deployed with two inflations up to 16 atmospheres.

After removal of balloons and wires, we had TIMI-3 flow with no
perforation, dissection or distal embolization.

IMPRESSION:
1.  THREE-VESSEL CORONARY DISEASE, STATUS POST PERCUTANEOUS
REVASCULARIZATION WITH PLACEMENT OF FOUR BARE METAL STENTS.


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## theresa.dix@tennova.com (Feb 27, 2013)

maryann1224@bellsouth.net said:


> Need some help with the new codes; since patient admitted w/ STEMI; would these codes be correct?    92941, 92928 LD, 92928 RC...Thank you for any assistance.
> 
> PROCEDURES PERFORMED
> 1.  Angioplasty and stenting of the circumflex artery.
> ...



I believe your code choice is correct. They placed four stents but one was a bridging stent. 

One thing I did not see is the infarct vessel was not identified for the 92941 code. ?? Am I missing something.?


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## maryann1224@bellsouth.net (Feb 27, 2013)

thank you theresa for your response, so I should have the dr specify which vessel the infarct was in? i read the consult and progress notes; but its not mentioned in there either. thank you again!


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