# L hrt cath w/l ventriculogram, ivus eval of l/anterior descending pre/post stenting



## cardiology101 (Jun 28, 2011)

Again new to cardiology, I will try to code this but am in need of some help I'm sure.

PROCEDURE:  L/HRT CATH W/L VENTRICULOGRAM
                     IVUS EVAL OF L.ANTERIOR DESCENDING PRE/POST STENTING
                     PTCA/STENTING MIDE LEFT ANTERIOR DESCENDING
                     INTRACORONARY NITROGLYCERIN INJECTIONS DURING PROCEDURE

DESCRIPTION:  Lidocaine injected into right groin w/o complications.  Sedlinger technique,
                       6 french sheath was placed in right common femoral artery w/o
                       complications.  Exchanges were done over a wire.  Judkins right 
                       and left catheters were then used to engage the coronary ostia.
                       Judkins JL-5cm catheter was required to engage left main.
                      Pigtail placed in the aorta over a wire and the aortic valve was
                      crossed.  Left ventriculogram and left ventricular end diatolic
                      pressure was measured.  The gradient across the aortic valve 
                      was measured.  Angio seal closure device was used to close
                      the right groin w/o complications.  

HEMODYNAMIC:  BP ranged from 149/87 to 108/60 and HR was 70.  No gradient
                         across aortic valve on retrograde pullback.

INTERVENTIONAL PROCEDURE:  Confirming an intermediate 60% lesion in the left
                                               anterior descending, began to proceed with an
                                               intravascular ultrasound eval of this lesion.  Done
                                               with intravenous heparin .  The IVUS
                                               demonstrated a cross sectional area @ the
                                               tighest portion of 3.1 to 3.3mm sq 65% stenosis.
                                               Proceeded with angioplasty and stenting of this
                                               lesion.  EBU 4.5 quide was used over a floppy wire,
                                               since already present.  Angioplastied the lesion
                                               using 3.0 x 12 angioplasty balloon.  Following a 3.0 x 15
                                               Xience stent deployed to high atmospheric pressure.
                                               Lesion postdilated using 3.0 x10 mm postdilation
                                               noncompliant balloon.  Final IVUS showed excellent 
                                               stent expansion.  no evidence of proximal or distal
                                               dissection and final cross sectional are of 5.9 mm sq.

Here is my analysis:

L/HRT CATH W/L VENTRICULOGRAM............93452-59
IVUS..........................................................37250-59
PTCA L/ANTERIOR DESCENDING...................92982-LD
STENTING L/ANTERIOR DESCENDING............92980-LD
INTRACORONAY NITROGLYCERIN INJ............37202-59

Again you help is greatly appreciated.


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## dadhich.girish (Jun 28, 2011)

*My opinion*

I would code only following:

92980-LD - LAD stenting (including angioplasty)
93452-51 - Lt. heart cath with vgram
92978 – IVUS

Rest bundled.

HTH.


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