# Code review assistance Intraaortic balloon pump



## calorom2 (Jan 11, 2018)

Could someone please review my codes? Thanks for your help!

93461-26
33967
93567


PROCEDURES:
1. Right and left heart catheterization.
2. Coronary angiography.
3. Saphenous vein graft to distal RCA/PDA angiography.
4. LIMA-LAD/diagonal angiography.
5. Proximal aortogram.
6. Distal aortogram into the iliacs and common femoral artery.
7. Intra-aortic balloon pump insertion.
COMPLICATIONS:
None.
BLOOD LOSS:
Approximately 50 mL.
APPROACH:
Left common femoral artery and left common femoral vein.
INDICATIONS:
Cardiogenic shock in a patient with history of severe dilated ischemic cardiomyopathy,
ejection fraction of 20%, congestive heart failure. The patient was intubated before
cardiac catheterization due to severe congestive heart failure with hypoxemia.
The risks and benefits of cardiac catheterization were discussed with the patient. He was
agreeable to the procedure. Consent was obtained.
Time-out was performed. The patient's position and procedure to be performed were
identified.
The patient was prepped and draped in normal fashion. 1% lidocaine was generously
infiltrated into the left groin region. The common femoral vein was accessed and a
6-French sheath was introduced without difficulty. Pulsatile flow was noted in the common
femoral vein.
The left common femoral vein was accessed and a 6-French sheath was introduced. Selective
coronary angiography was performed using 6-French JL-4 and JR4. Aortogram was performed
using a 6-French pigtail. All catheter exchanges were performed over a long J-wire and a
Manifold double flushing between all catheter exchanges. Multiple RAO and LAO with
cranial and caudal angulations were obtained.
Right heart catheterization. RA sat 55%, PA sat 63%, arterial sat 85%.
Right heart filling pressures, RA mean 35 mmHg, PA 51/33 mmHg. The mean pulmonary artery
pressure is 42 mmHg. The mean pulmonary capillary wedge pressure is 35 mmHg.
Coronary angiography: Left main is large, short with distal 20 to 30% tapering stenosis.
The left anterior descending artery, circumflex artery branch in normal fashion.
The left anterior descending artery proximal segment had 70 to 80% stenosis. The mid
segment was totally occluded. The large diagonal branch was without significant disease.
The circumflex artery proximal segment had 30 to 40% stenosis. The circumflex artery
continues into a very large obtuse marginal branch in the mid segment. A small AV
circumflex groove is without significant disease. The mid circumflex and large obtuse
marginal branch were without significant disease.
The right coronary artery was totally occluded in the proximal segment.
Vein graft to the distal RCA/PDA was patent. The PDA was notably small, diffusely
diseased vessel.
LIMA angiography to the LAD/diagonal was a large vessel and patent.
The left ventricular end-diastolic pressure was approximately 35 mmHg.
Left ventriculogram was not performed due to hypotension and elevated LVEDP. Bileaflet
mechanical mitral valve replacement is noted. The leaflets appear to open and close
normally.
Proximal aortogram showed no significant aortic valve insufficiency. No significant
additional vein grafts are noted in the proximal aorta. The ascending, transverse, and
proximal descending aorta was without significant dilatation.
The pigtail catheter was withdrawn into the distal aorta. Angiogram of the distal aorta
showed a small saccular aneurysm. The right and left internal and external iliac arteries
were without significant disease. The left common femoral artery was without significant
disease.
A 7-French 50 mL intra-aortic balloon pump was placed to the level of the carina. The
balloon pump was placed on one-to-one augmentation. Excellent systolic and diastolic
augmentation
are noted. The patient remained stable during the procedure and was transferred back to
the intensive care unit in stable condition.


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## carolhodge (Jan 12, 2018)

I would add a 59 modifier to the 33967


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