# Left Heart Cath - radial approach



## amym (Feb 7, 2012)

Our physician is billing a left heart cath (radial approach).  Would this impact my coding of 93458?  I know almost all caths are performed through the patients groin! 

SUMMARY: 

--  CORONARY CIRCULATION: 
--  There was 1-vessel coronary artery disease ( 75 % circumflex). 

--  CARDIAC STRUCTURES: 
--  Global left ventricular function was normal. EF calculated by contrast 
ventriculography was 60 %. 

PROCEDURES PERFORMED: 

--  Left heart catheterization with ventriculography. 
--  Right coronary angiography. 
--  Left coronary angiography. 
--  Hemostasis with TR Band. 

RECOMMENDATIONS: 
May need OM stent if CP recurrent. 

INDICATIONS: Angina/MI: unstable angina. 

VENTRICLES: There were no left ventricular global or regional wall motion 
abnormalities. Global left ventricular function was normal. EF calculated 
by contrast ventriculography was 60 %. 

VALVES: AORTIC VALVE: The aortic valve was evaluated by left 
ventriculography. The aortic valve appeared to be structurally normal. The 
aortic valve leaflets exhibited normal thickness and normal excursion. 
There was no aortic stenosis. MITRAL VALVE: The mitral valve was evaluated 
by left ventriculography. The mitral valve appeared grossly normal. The 
mitral leaflets exhibited normal thickness and normal excursion. The 
mitral valve exhibited no regurgitation. 

CORONARY VESSELS: The coronary circulation is right dominant. There was 
1-vessel coronary artery disease ( 75 % circumflex). Left main: Normal. 
LAD: Normal. Circumflex: Angiography showed minor luminal irregularities. 
1st obtuse marginal: There was a 75 % stenosis. There was TIMI grade 3 
flow through the vessel (brisk flow). RCA: Normal. 

PROCEDURE: The risks and alternatives of the procedures and conscious 
sedation were explained to the patient and informed consent was obtained. 
The patient was brought to the cath lab and placed on the table. The 
planned puncture sites were prepped and draped in the usual sterile 
fashion. 

--  Right radial artery access. The puncture site was infiltrated with 
local anesthetic. The vessel was accessed using the modified Seldinger 
technique, a wire was threaded into the vessel, and a catheter was 
advanced over the wire into the vessel. 

--  Left heart catheterization. A catheter was advanced to the ascending 
aorta. After recording ascending aortic pressure, the catheter was 
advanced across the aortic valve and left ventricular pressure was 
recorded. Ventriculography was performed using power injection of contrast 
agent. Imaging was performed using an RAO projection. 

--  Right coronary artery angiography. A catheter was advanced to the 
aorta and positioned in the vessel ostium under fluoroscopic guidance. 
Angiography was performed in multiple projections using hand-injection of 
contrast. 

--  Left coronary artery angiography. A catheter was advanced to the aorta 
and positioned in the vessel ostium under fluoroscopic guidance. 
Angiography was performed in multiple projections using hand-injection of 
contrast. 

--  Hemostasis with TR Band.. 

COMPLICATIONS: 
None occurred during the cath lab visit. 
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING: 
Test started at 14:43. Test concluded at 15:34. RADIATION EXPOSURE: 
Fluoroscopy time: 1.4 min. 
MEDICATIONS GIVEN: 
Midazolam, 1 mg, IV, at 14:43. 
Midazolam, 1 mg, IV, at 14:47. 
Verapamil (Isoptin, Calan, Covera), 1.25 mcg, intracoronary, at 14:48. 
Nitroglycerin, 400 mcg, intracoronary, at 14:48. 
Heparin, 3000 units, IA, last dose at 14:49. 
1% Lidocaine, 6 ml, subcutaneously, at 14:43. 
CONTRAST GIVEN: 
Omnipaque 125 ml. 

STUDY DIAGRAM 

Angiographic findings 
Native coronary lesions: 
7OM1: Lesion 1: 75 % stenosis. 

HEMODYNAMIC TABLES 

Pressures:  NO PHASE 
Pressures:  - HR: 79 
Pressures:  - Rhythm: 
Pressures:  -- Aortic Pressure (S/D/M): 119/78/98 
Pressures:  -- Left Ventricle (s/edp): 123/9/-- 

Outputs:  NO PHASE 
Outputs:  -- CALCULATIONS: Age in years: 54.79 
Outputs:  -- CALCULATIONS: Body Surface Area: 2.64 
Outputs:  -- CALCULATIONS: Height in cm: 183.00 
Outputs:  -- CALCULATIONS: Sex: Male 
Outputs:  -- CALCULATIONS: Weight in kg: 149.70


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## Vicki Graham (Feb 7, 2012)

The radial access vs. femoral access would not change the code 93458. Thanks!


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