# Lhc



## rparikh (Mar 13, 2012)

What code should I use for this rpt
this is what I have ---LHC 93458, 93567 or should I use for BHC- 93460, 93567
PROCEDURES:
1.  Left heart catheterization.
2.  Bilateral selective coronary artery angiography.
3.  Left ventriculogram.
4.  Ascending aorta angiography.
5.  Right common femoral artery angiography.
6.  Perclose ProGlide closure device to achieve hemostasis.

INDICATIONS:
There is a 67-year-old male with history of diabetes type 2 who
presented with complaint of chest pain.  The patient underwent exercise
treadmill test and developed shortness of breath and chest pain during
the procedure.  The patient also noted to have some apical ischemia.
The patient was subsequently brought to the cardiac catheterization lab
for left heart catheterization due to the patient's diabetes (high risk
for coronary artery disease) and abnormal stress test.

DESCRIPTION OF PROCEDURE:
Informed consent obtained.  The patient brought to the catheterization
lab in fasting state.  The patient's right groin prepped and draped in
sterilized fashion.  Lidocaine 1% was used to anesthetize the right
groin.  A Cook needle was used to obtain access to the right common
femoral artery.  Access obtained via modified Seldinger technique.  A 6
French standard sheath was inserted into the right common femoral
artery.  A JL4.0 and JR4.0 catheter was used to perform the bilateral
selective coronary artery angiography.  The pigtail catheter was used to
perform the left ventriculogram and the ascending aorta angiography.
Then the right common femoral artery angiography was performed.  The
needle insertion above bifurcation and below the inferior epigastric
artery, which is suitable for closure device.  A Perclose ProGlide
closure device was used to achieve hemostasis.  Hemostasis achieved
without any complication.  The patient was transferred back to PICA for
further observation.

FINDINGS:
HEMODYNAMICS:
The LV pressure was 140/10.  The left ventricular end-diastolic pressure
was 24 mmHg.  The aorta pressure was 140/70.  There was no gradient
noted across the aortic valve.

LEFT VENTRICULOGRAM:
The left ventricle is small in size.  There is evidence of hypertrophy.
The left ventricular fraction is hyperdynamic with left ventricular
end-diastolic function more than 65%.  There was no evidence of mitral
regurgitation.

ASCENDING AORTA ANGIOGRAPHY:
The ascending aorta is normal in size.  Aortic valve is trileaflet.  There is
no evidence of dissection or aneurysm.  There is no evidence of aortic
regurgitation.

BILATERAL SELECTIVE CORONARY ANGIOGRAPHY:
LEFT CORONARY SYSTEM
Left main is normal in size.  It bifurcates into left anterior
descending artery and left circumflex artery.  There was no significant
stenosis noted.

Left anterior descending artery:  The left anterior descending artery is
a normal size and tortuous vessel.  It gives rise to 1 diagonal branch
and multiple septal perforators.  Distally it travels toward apex and
wraps around the apex.  There is evidence of 20% stenosis with some
calcification noted at the proximal left anterior descending artery
right at the bifurcation to the diagonal 1 branch.  There is also
20% stenosis at the ostium of diagonal 1 branch.

Left Circumflex Artery:  The left circumflex artery is a very large
vessel.  It is the dominant vessel.  It is also tortuous in nature.  It
gives rise to 1 large obtuse marginal branch which further bifurcates
and distally gives rise to branches traveling toward the posterolateral
wall.  There is no significant disease in the left circumflex artery.

Right coronary artery:  The right coronary artery is a small size
caliber vessel.  It is nondominant.  It gives rise to the conus branch,
RV marginal branch.  There is some mild luminal irregularity in the
proximal to mid right coronary artery:



There is evidence of rapid filling from the left coronary artery system to the left
ventricle suggestive of coronary artery to a left ventricle fistula.

RIGHT COMMON FEMORAL ARTERY ANGIOGRAPHY:
The right common femoral artery is a regular size caliber vessel.  It
bifurcates into superficial femoral and deep profunda artery.  The
needle insertion is above the bifurcation and below the inferior
epigastric artery, which is suitable for closure device.  There is no
evidence of any stenosis noted.

IMPRESSION:
1.  The patient has nonobstructive coronary artery disease with 20%
stenosis in the proximal left anterior descending right at the
bifurcation of the diagonal branch.  There is also evidence of 20%
stenosis in the ostium of the diagonal branch.
2.  There is evidence of coronary artery to left ventricle fistula with
a rapid filling from the coronary artery to the left ventricle.
3.  Diastolic dysfunction with left ventricular end-diastolic pressure
at 24 mmHg.
4.  Hyperdynamic left ventricle with small left ventricular cavity.  The
left ventricular ejection fraction is more than 65%.

RECOMMENDATION:
To continue medical management for the nonobstructive coronary artery
disease including aspirin, statins, ACE inhibitor and would add a
beta-blocker, Toprol 25 mg daily to his regimen.


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## Jess1125 (Mar 13, 2012)

rparikh said:


> What code should I use for this rpt
> this is what I have ---LHC 93458, 93567 or should I use for BHC- 93460, 93567
> PROCEDURES:
> 1.  Left heart catheterization.
> ...



First group, 93458 and 93567. 

(You don't have a right heart catheterization being done here. Only left heart cath with the aortography)

Jessica CPC, CCC


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