# Cath + Angio



## amym (Jun 3, 2011)

Is it appropriate to code this as 93458-26, 75710-26-59?

PROCEDURES PERFORMED: 

--  Left heart catheterization with ventriculography. 
--  Left coronary angiography. 
--  Right coronary angiography. 
--  Aorta Iliac Unilateral. 
--  Right leg angiography. 

RECOMMENDATIONS: 
Only RLE imaging was performed in the cath lab. 

Severe disease involving the RLE was visualized only to the level of TP 
trunk. 

A full LE run-off and Atherectomy of the LE shall be scheduled in two 
weeks. 

No dye reaction occurred (pt was premedicated). 

INDICATIONS: Angina/MI: atypical chest pain. 

PRIOR DIAGNOSTIC TEST RESULTS: Nuclear pharmacologic stress test was 
positive. 

VENTRICLES: There were no left ventricular global or regional wall motion 
abnormalities. 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. Coronary 
angiography demonstrated minor luminal irregularities. Left main: 
Angiography showed minor luminal irregularities. LAD: Angiography showed 
minor luminal irregularities. Mid LAD: There was a 30 % stenosis. 
Circumflex: Angiography showed minor luminal irregularities. RCA: 
Angiography showed minor luminal irregularities. 

RIGHT LOWER EXTREMITY VESSELS: Right lower extremity angiography reveals 
severe atherosclerosis. Proximal right deep femoral: There was a 70 % 
stenosis. Mid right deep femoral: There was a 80 % stenosis. Distal right 
deep femoral: There was a 80 % stenosis. Proximal right anterior tibial: 
There was a 100 % stenosis. Right posterior tibial: There was a 100 % 
stenosis. 

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 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 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. 

--  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. 

--  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. 

--  Aorta Iliac Unilateral. 

--  Right leg angiography. A catheter was positioned. 

COMPLICATIONS: 
There were no adverse outcomes. 
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING: 
Test started at 09:47. Test concluded at 10:05. RADIATION EXPOSURE: 
Fluoroscopy time: 2 min. 
HEMOSTASIS: 
The sheath was removed. The site was compressed manually. Hemostasis was 
successful. 
MEDICATIONS GIVEN: 
Midazolam, 1 mg, IV, at 09:44. 
CONTRAST GIVEN: 
Omnipaque 35 ml.


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## dpeoples (Jun 3, 2011)

amym said:


> Is it appropriate to code this as 93458-26, 75710-26-59?
> 
> PROCEDURES PERFORMED:
> 
> ...



I agree with your code choices.

HTH


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