# Cor Angio and FFR



## amym (Jun 13, 2013)

Was this appropriately coded at 93454-26, 93571-26 (for lad), 93572-26 (for lcx)?

PROCEDURES PERFORMED: 

--  Left coronary angiography. 
--  Intervention on mid LAD: percutaneous intervention. (NOT DONE) 

RECOMMENDATIONS: 
The patient should continue with the present medications. 

INDICATIONS: Angina/MI: atypical chest pain. Coronary artery disease: 
abnormal stress test. 

HEMODYNAMICS: Hemodynamic assessment demonstrates normal hemodynamics. 

VENTRICLES: Global left ventricular function was normal. EF calculated by 
contrast ventriculography was 65 %. 

CORONARY VESSELS: The coronary circulation is right dominant. 

(1) Left main is patent with no significant disease 
(2) LAD had diffuse 5-10% stenosis with a focal lesion in the mid LAD that 
is 40-50% 
(3) LCX has a patent stent with mild ISR 10-20% 
(4) RCA is a dominant vessel with no flow limiting lesions 
(5) EF is 60-65% 
(6) FFR of LAD with 90 and 120 showed FFR of 0.91 and 0.86 respectively 
(7) FFR of LCX with 90 and 120 showed FFR of 0.86 and 0.84 respectively. 
(8) Optimize medical TX at this time. 

. Distal left main: Normal. Proximal LAD: Normal. Mid LAD: There was a 
discrete 50 % stenosis. Distal LAD: Angiography showed minor luminal 
irregularities. Proximal circumflex: Normal. Mid circumflex: There was a 
tubular 20 % stenosis at the site of a prior stent. Distal circumflex: 
Normal. Proximal RCA: Angiography showed minor luminal irregularities. Mid 
RCA: Angiography showed minor luminal irregularities. Distal RCA: 
Angiography showed minor luminal irregularities. Right posterolateral 
segment: Angiography showed minor luminal irregularities. 


--  Right femoral 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 sheath was advanced 
over the wire into the vessel. 

--  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. 

LESION INTERVENTION: A percutaneous intervention was performed on the 
lesion in the mid LAD. There was no dissection. (not done)

--  Myocardial Fractional Flow Reserve (FFR) measurement was performed 
using a 0.014" pressure-monitoring 300cm Certus Pressure guide-wire. 
Steady baseline values were obtained. Mean arterial pressure and mean 
distal coronary pressures were then obtained at maximum hyperemia. 

--  Myocardial Fractional Flow Reserve (FFR) measurement was performed 
using a 0.014" pressure-monitoring 300cm Certus Pressure guide-wire. 
Steady baseline values were obtained. Mean arterial pressure and mean 
distal coronary pressures were then obtained at maximum hyperemia. 


STUDY DIAGRAM 

Angiographic findings 
Native coronary lesions: 
7Mid LAD: Lesion 1: discrete, 50 % stenosis. 
7Mid circumflex: Lesion 1: tubular, 20 % stenosis, site of prior stent. 
Intervention results 
Native coronary lesions: 
7 percutaneous intervention of mid LAD. 

HEMODYNAMIC TABLES 

Pressures:  Baseline 
Pressures:  - HR: 87 
Pressures:  - Rhythm: 
Pressures:  -- Aortic Pressure (S/D/M): 199/111/147 
Pressures:  -- Left Ventricle (s/edp): 175/38/-- 

Outputs:  Baseline 
Outputs:  -- CALCULATIONS: Age in years: 62.50 
Outputs:  -- CALCULATIONS: Body Surface Area: 1.81 
Outputs:  -- CALCULATIONS: Height in cm: 157.00 
Outputs:  -- CALCULATIONS: Sex: Female 
Outputs:  -- CALCULATIONS: Weight in kg: 80.7


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## Jess1125 (Jun 14, 2013)

Your codes for FFR are OK but I would actually bill 93458-26 instead of 93454-26. I noticed that ventriculography was done which means the provider crossed the aortic valve. You have a LHC w/ coronaries here. 

Jessica CPC, CCC


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