# Left heart cath, femoral arteriogram, pressure wire



## OPENSHAW (May 28, 2013)

How would you code the following:

1.  Left heart catheterization
2.  Selective right and left coronary arteriograms
3.  Selective right subclavian arteriogram
4.  Left subclavian arteriogram
5.  Selective right internal mammary artery arteriogram
6.  Selective left internal mammary artery arteriogram
7.  Left ventriculogram
8.  Selective right femoral arteriogram
9.  Percutaneous transluminal coronary angioplasty to the obtuse marginal branch of the left anterior descending artery and pressure wire placement in the diagonal past the proximal left anterior descending artery and coronary flow measurement after 140 mcg/kg of adenosine for 3 minutes

preoperative diagnosis:
1.  Coronary artery disease status post aortocoronary bypass
2.  Chest pain
3.  Pulmonary emboli

postoperative diagnosis:
1.  Coronary artery disease status post aortocoronary bypass
2.  Status post percutaneous transluminal coronary angioplasty
3.  Pulmonary emboli


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## Cyndi113 (May 29, 2013)

It would help if you posted the procedure note.


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## OPENSHAW (May 29, 2013)

description of procedure:
After informed consent, the right groin was prepped in the usual sterile fashion. After it was done, a cooke needle was placed in the right femoral artery without any difficulty. Through this sheath, a j wire was utilized and a 6 french sheath was placed in the right femoral artery without any difficulty. Through this sheath, several catheters were utilized. The 1st catheter utilized was a jl 4. This was placed in the ostium of the left coronary artery and several views of the left coronary were obtained.
The catheter withdrawn over the wire. The next catheter utilized was a jr 4. This catheter was placed in the ostium of the right coronary and several views of the right coronary were obtained. This catheter was rotated and was placed in the right subclavian and the right subclavian arteriogram was performed. However, this catheter the tip of the was not good enough to selectively inject the rima. Therefore, the catheter was changed. The long j wire was utilized and the catheter was changed to a lima catheter. This lima catheter was advanced through subclavian to the rima and rima arteriogram was performed. The catheter was rotated into the left subclavian and left subclavian arteriogram was done. This showed non-occlusive disease. The catheter was then advanced to the lima and selective lima arteriogram was performed. This catheter was withdrawn over the wire. The next catheter utilized was an angled pigtail. This was placed in the aorta and advanced into the lv under hemodynamic monitoring. An lv gram was performed. The catheter was withdrawn into the aorta under hemodynamical monitoring then withdrawn over a. Hemodynamic findings: The aortic pressure was 137/72, the lv pressure was 115, end-systolic was 137, with an end-diastolic of 3 to 8.

Angiographic findings: The left coronary was injected in several views; in the ap, ap caudal, rao caudal, lao caudal, rao cranial, ap cranial, rao cranial. He was found to have a lesion in the proximal lad with very large diagonal. The circumflex exhibited small proximal vessel. There was a tight lesion in the obtuse marginal-1 where the stent was placed before. The rest of the circumflex was small. The right coronary artery was injected in 1 view with a 100% occluded right coronary artery. The rima was injected selectively and it showed a patent rima with anastamosis the pda with some non-occlusive disease. The lima also was injected selectively and showed selective lima with small distal lad. Because of the above findings, it was then decided to proceed with pressure wire. The pressure wire was placed in the distal diagonal and 140 mcg/kg/minute of adenosine was used for 3 minutes, and the coronary flow was measured and the ffr was 0.87, so we decided that this lesion was not significant. Then we decided to proceed to go for the lesion in the obtuse marginal branch. The wire utilized was asahi prowater. This was placed in the distal portion of the obtuse marginal branch, and this was followed by a 2.25 x 12 nc trek was placed in the lesion and dialated to 14 atmospheres. The pre-dilation stenosis was 99%. The post-dilation stenosis was 0%. The patient tolerated the procedure well. Also right femoral arteriogram was performed and showed nonocclusive disease and the right and left subclavian arteriogram also showed nonocclusive disease. After it was done, 8 french angio seal was used to close the arteriotomy. The patient tolerated the procedure well. He was sent to recovery room in stable condition.

92920-lc, dx. 411.1, 415.19
93458-59-26, dx. 414.00
93571, dx. 414.00

is this right?


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## TWinsor (May 29, 2013)

what about 

92980-LC       414.01
93459-26-59   786.50, 414.01
93571-26        414.01

I believe since LIMA/RIMA sel angio the 93459 instead of the 93458

HTH!


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## OPENSHAW (May 29, 2013)

description of procedure:
After informed consent, the right groin was prepped in the usual sterile fashion. After it was done, a cooke needle was placed in the right femoral artery without any difficulty. Through this sheath, a j wire was utilized and a 6 french sheath was placed in the right femoral artery without any difficulty. Through this sheath, several catheters were utilized. The 1st catheter utilized was a jl 4. This was placed in the ostium of the left coronary artery and several views of the left coronary were obtained.
The catheter withdrawn over the wire. The next catheter utilized was a jr 4. This catheter was placed in the ostium of the right coronary and several views of the right coronary were obtained. This catheter was rotated and was placed in the right subclavian and the right subclavian arteriogram was performed. However, this catheter the tip of the was not good enough to selectively inject the rima. Therefore, the catheter was changed. The long j wire was utilized and the catheter was changed to a lima catheter. This lima catheter was advanced through subclavian to the rima and rima arteriogram was performed. The catheter was rotated into the left subclavian and left subclavian arteriogram was done. This showed non-occlusive disease. The catheter was then advanced to the lima and selective lima arteriogram was performed. This catheter was withdrawn over the wire. The next catheter utilized was an angled pigtail. This was placed in the aorta and advanced into the lv under hemodynamic monitoring. An lv gram was performed. The catheter was withdrawn into the aorta under hemodynamical monitoring then withdrawn over a. Hemodynamic findings: The aortic pressure was 137/72, the lv pressure was 115, end-systolic was 137, with an end-diastolic of 3 to 8.

Angiographic findings: The left coronary was injected in several views; in the ap, ap caudal, rao caudal, lao caudal, rao cranial, ap cranial, rao cranial. He was found to have a lesion in the proximal lad with very large diagonal. The circumflex exhibited small proximal vessel. There was a tight lesion in the obtuse marginal-1 where the stent was placed before. The rest of the circumflex was small. The right coronary artery was injected in 1 view with a 100% occluded right coronary artery. The rima was injected selectively and it showed a patent rima with anastamosis the pda with some non-occlusive disease. The lima also was injected selectively and showed selective lima with small distal lad. Because of the above findings, it was then decided to proceed with pressure wire. The pressure wire was placed in the distal diagonal and 140 mcg/kg/minute of adenosine was used for 3 minutes, and the coronary flow was measured and the ffr was 0.87, so we decided that this lesion was not significant. Then we decided to proceed to go for the lesion in the obtuse marginal branch. The wire utilized was asahi prowater. This was placed in the distal portion of the obtuse marginal branch, and this was followed by a 2.25 x 12 nc trek was placed in the lesion and dialated to 14 atmospheres. The pre-dilation stenosis was 99%. The post-dilation stenosis was 0%. The patient tolerated the procedure well. Also right femoral arteriogram was performed and showed nonocclusive disease and the right and left subclavian arteriogram also showed nonocclusive disease. After it was done, 8 french angio seal was used to close the arteriotomy. The patient tolerated the procedure well. He was sent to recovery room in stable condition.

92920-lc, dx. 411.1, 415.19
93458-59-26, dx. 414.00
93571, dx. 414.00

is this right?


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## mabar1571 (May 31, 2013)

93459 -LHC w.graft angio


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