# Help with Heart Cath



## armymomryan (May 18, 2011)

I've gotten pretty good with the basic heart cath and sent out approximately 400 copies of the 2011 new cath codes chart to a lot of you, but now I need some help;

Procedure;
Coronary angiography, percutaneous coronary intervention ostial right coronary artery lesion, balloon dilatation, and cutting balloon atherectomy, drug eluting stent deployment, intracoronary nitroglycerin, right femoral angiogram and StarClose hemostasis.

Here is the dictation as provioded by my doc;

  I was called to the cath lab after Dr. XXX had done a diagnostic cath with the finding of a significant in-stent stenosis at the ostium of the right cor. artery which was complicated by the previously placed stent protruding into the sinus of Valsalva.  After several attempts at subselecting the right coronary ostia, ultimately an XBRCA cath proved best. A whisper wire was advanced distally and the patient received a bolus and infusion Angiomax w/ an ACT of 428.  Initial attempts at balloon dilatation of the in-stent stenosis were challenged by a watermelon seeding affect with a 3.0 x 12 mm balloon dilatation system.  This was then exchanged for a 3.0 x 10 mm cutting balloon which was deployed several times to the proximal RCA and ostia.  This was then exchanged for a 3.0 x 15 mm Xience drug-eluting stent which was initially deployed at 9 atmospheres and followed up with balloon dilatation at 12 and 16 atmospheres.  Follow-up angiography showed mild residual narrowing at the ostia and a 3.0 x 8 mm non-compliant stent was then deployed and serial dilatations to the ostia and proximal right coronary artery to a peak of 22 atmospheres.  Intracoronary nitroglycerin was given after several of the balloon inflations.  Follow-up angiography showed no residual stenosis.  No evidence of dissection or distal flow problems.  Right femoral angiogram showed appropriate placement of the previously placed introducer and a StarClose device was then deployed.

Any help is greatly appreciated.


----------



## Jim Pawloski (May 18, 2011)

armymomryan said:


> I've gotten pretty good with the basic heart cath and sent out approximately 400 copies of the 2011 new cath codes chart to a lot of you, but now I need some help;
> 
> Procedure;
> Coronary angiography, percutaneous coronary intervention ostial right coronary artery lesion, balloon dilatation, and cutting balloon atherectomy, drug eluting stent deployment, intracoronary nitroglycerin, right femoral angiogram and StarClose hemostasis.
> ...



93454 - Coronary Angio
92980-RC or G0290-RC(Medicare) - Coronary Stent
Cutting balloon is the same as PTCA.  Stent supersedes PTCA
Nitro is bundled into procedure.
HTH,
Jim Pawloski, CIRCC


----------



## armymomryan (May 20, 2011)

I was counting on your reply Jim, you are always a great help - Thank you !!


----------

