# Stent-Angina pectoris



## nancy.anselmo@ccrheart.com (Mar 1, 2013)

Ok, with all the denials for extra stents not sure what to bill

INDICATIONS: Angina pectoris.

PROCEDURES: Left heart catheterization, selective coronary angiography, left ventriculography with complex percutaneous intervention of the bifurcation lesion of the LAD/diagonal with placement of Resolute drug-eluting stents

HISTORY OF PRESENT ILLNESS: The patient is a 76 year old who presented with accelerating symptoms of shortness of breath and dyspnea on exertion. She was placed on medical therapy and underwent an exercise treadmill test, had poor exercise performance 
with reproduction of her symptoms as well as multiple regional wall motion abnormalities consistent with ischemia. This was considered a high-risk stress test and with class III symptoms was referred for diagnostic angiography.

PROCEDURE: Informed consent was obtained, the patient understood the risks, benefits and alternatives of the procedure and agreed to proceed with the procedure. The right wrist was prepped in the usual sterile fashion and 2% lidocaine infused 
subcutaneously until adequate anesthesia was obtained. Right radial artery accessed using the modified Seldinger technique of which a 6-French 250-mm Glidesheath was placed without complication. A 6-French Jacky catheter was used to perform selective 
coronary angiography, left heart catheterization, left ventriculography At the conclusion of the procedure, a TR band was placed. There was a moderate-sized hematoma and a 2nd TR band was placed in order to achieve adequate hemostasis.

HEMODYNAMICS: Left ventricular end-diastolic pressure measured 7 mmHg. There was no transaortic gradient on pullback.

LEFT VENTRICULOGRAPHY: Demonstrated preserved left ventricular function, ejection fraction of 55%.

CORONARY ANGIOGRAPHY:
LEFT MAIN: Mild disease.

LAD: Had a complex bifurcation lesion extending from the proximal LAD into the 1st diagonal. There was about a 90% stenosis seen in the main body of the LAD leading into an 80% tubular stenosis seen in the 1st diagonal. The remaining aspect of the 
vessel had mild disease.

LEFT CIRCUMFLEX: Had about 30% ostial stenosis giving off 2 prominent marginal branches with mild disease.

RCA: Mild disease giving off the PDA, there is moderate disease with 40% midvessel stenosis.

SUMMARY: Severe single-vessel coronary artery disease in the complex bifurcation of the LAD and diagonal. Normal left ventricular filling pressures, normal left ventricular function.

CLINICAL PATHWAY: Based on the patient's angiographic findings, accelerating symptoms and high-risk stress test, he has elected to proceed with angioplasty.

INTERVENTION: Angiomax was used for effective anticoagulation and an EBU 3.75 guide catheter was used to intubate the left main coronary artery. A Runthrough wire was placed to the distal LAD and a 2nd Runthrough wire was placed to the distal diagonal.
A 2.5 balloon was used to dilate both lesions sequentially. Next, a 2.5 x 18 Resolute was then placed across the LAD covering the ostium of the first diagonal. This was deployed with an excellent angiographic result. The LAD wire was then rewired 
through the stent struts and back into the distal LAD. Next, a 2.5 noncompliant balloon was used to predilate through the previously stented struts. This allowed passage of a 27514 Resolute. The diagonal wire was then removed and the stent was then 
deployed to 16 atmospheres. Next, the Runthrough wire was then renavigated through not only the LAD stent but also the previously placed diagonal stent into the main body of the diagonal. A 2.5 balloon was then used to dilate the stent struts. A 2.5 
noncompliant balloon was then deployed in a kissing fashion with a 2.5 compliant balloon at the carina of the bifurcation of the LAD and diagonal, each to 10 atmospheres respectively with an excellent angiographic result.

SUMMARY: Successful complex bifurcation stenting of the LAD diagonal with placement of Resolute drug-eluting stents.


93458-26-59
92928-LD
92929-
What modifiers are used on the 92929? Thank you Nancy


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## Jess1125 (Mar 1, 2013)

nancy.anselmo@ccrheart.com said:


> Ok, with all the denials for extra stents not sure what to bill
> 
> INDICATIONS: Angina pectoris.
> 
> ...



Codes are OK. Modifier -LD on the 92929.

Jessica CPC, CCC


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## nancy.anselmo@ccrheart.com (Mar 4, 2013)

Thank you so much, I'll get the hang. Oh! then ICD-10 will kick in


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