# Lt heart Cath +



## amym (May 23, 2013)

Please help with coding.  He performed a left heart cath, selective bilateral coronary angiography, left ventriculography, thoracic aortography. 

Procedure: Bilateral femoral regions were prepped and draped in the usual sterile fashion. 1% Xylocaine was infiltrated over the right common femoral artery region.  Next, a 4-French arterial sheath was inserted into the right common femoral artery using modified Seldinger technique.  A second bilateral coronary angiography was performed in multiple orthogonal views using small hand injections of contrast and Judkins catheters.  Left heart catheterization and catheter pullback and left ventriculography was performed using a pigtail catheter under a continuous pressure monitoring and using hand injection contrast.  Next, thoracic aortography was performed in multiple views using a pigtail catheter at the level of the aortic sinuses of Valsalva and power injection of contrast.  Serial injections were made with 30 Ml of contrast at a rate of 15 Ml per second.  At the conclusion of the study, all catheters and guidweres were removed and the sheath was pulled with application of manual pressure to achieve adequate hemostasis.  Overall, there were no complications.  
HEMODYNAMIC DATA:
AO 102-59 (78)
LV 102/10
Left Ventriculography: Performed in the right anterior oblique projection.  Global left ventricular systolic function is normal.  Estimated ejection fraction is 60%. Normal regional wall motion.
Thoracic Aortography: Performed in multiple orthogonal views.  No significant aortic insufficiency is seen.  The aortic root appears normal in size.  There is mild atherosclerosis in the thoracic aorta.  There is evidence of an untruptured sinus of Valsalva aneurysm which appeals to be situated between the right coronary cusp and noncoronary cusp of the aortic sinuses.  
CORONARY ANGIOGRAPHY:
1.	Left main coronary artery: Aorse normally off the left coronary cusp and bifurcated into left anterior descending and left circumflex coronary arteries.  Minimal luminal irregularities are present, but no significant stenosis is noted.
2.	Left anterior descending coronary artery: There is moderate to servere eccentric stenosis of the proximal left anterior descending coronary artery seen predominantly in the right anterior oblique and caudal views.  This involves the ostium of the first diagonal branch.  The stenosis in the proximal left anterior descending coronary artery is estimated at 60%-70%.  In addition, the ostium in the first diagonal branch contains approximately an 80% ostial stenosis.  There are mild luminal irregularities distally with no significant stenosis.  
3.	Left circumflex coronary artery contains mile luminal irregularities with no significant stenosis.
4.	Right coronary artery is dominant vessel which contains mild luminal irregularities but is nonobstructed.  There is a 20% mid vessel stenosis.


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## Jim Pawloski (May 24, 2013)

amym said:


> Please help with coding.  He performed a left heart cath, selective bilateral coronary angiography, left ventriculography, thoracic aortography.
> 
> Procedure: Bilateral femoral regions were prepped and draped in the usual sterile fashion. 1% Xylocaine was infiltrated over the right common femoral artery region.  Next, a 4-French arterial sheath was inserted into the right common femoral artery using modified Seldinger technique.  A second bilateral coronary angiography was performed in multiple orthogonal views using small hand injections of contrast and Judkins catheters.  Left heart catheterization and catheter pullback and left ventriculography was performed using a pigtail catheter under a continuous pressure monitoring and using hand injection contrast.  Next, thoracic aortography was performed in multiple views using a pigtail catheter at the level of the aortic sinuses of Valsalva and power injection of contrast.  Serial injections were made with 30 Ml of contrast at a rate of 15 Ml per second.  At the conclusion of the study, all catheters and guidweres were removed and the sheath was pulled with application of manual pressure to achieve adequate hemostasis.  Overall, there were no complications.
> HEMODYNAMIC DATA:
> ...



93458, 93567
Jim Pawloski, CIRCC


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## AB87 (May 24, 2013)

Yes I agree also!


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