# Can someone please check..Cors only?



## Robbin109 (May 8, 2012)

RE: The cath, Would this just be 93454? What about the Aortic root? I don't see a seperate injection...or pressures in the left heart...thanks!!

*Procedure:*
Cardiac Catheterization

*PostProcedure Diagnosis:*

99% eccentric stenosis in the mid left anterior descending artery at the takeoff, a very large first septal perforator. The artery below this obstruction bifurcates into a smaller distal LAD and a very large diagonal branch that supplies most of the lateral wall of the left ventricle. The pt also has a high diagonal branch that has total chronic occlusion. This appears to be an old lesions.

The left circumflex coronary artery is also large and has a 40% to 50% mid stenosis, 40% proximal stenosis. The obtuse marginal branch has 40% stenosis and is large diastolic. The distal circ has no significant stenosis and is moderate in size.

The right coronary artery has a shepherd crook configuration and has had 40% to 50% proximal and mid stenosis, has irregularities in its distal segment. It gives a very large posterior descending coronary artery, which has only 30% to 40% ostial stenosis and a small posterolateral branch. 

The pt has morbid obesity, and has a dilated ascending aortic root.

The left main coronary artery has a high takeoff on the superior orientation and the right coronary artery has a low takeoff with a marked shepherd crook configuration.

Left ventricular angiogram was not performed in light of the difficulty associated with the performance of this procedure.

The patient initially was attempted to access in the right femoral artery, but this was unsuccessful so we switched to the left femoral artery. We were able to place a long sheath introducer in the left femoral vein. Two attempts at obtaining access to the left femoral artery were unsuccessful and we stopped the procedure and attempt, in order to proceed with radial approach to perform emergency primary PCI. The patient presented with diagnosis of acute ST elevation lateral wall infarction.

The patient's cardiac catheterizatiion was performed int eh right radial approach after checking the patency of the ulnar and radial artery.

percutaneous catheter was placed in the right radial artery, a 6-French introducer, hydrophilic.

I then advanced Tiger catheter which engaged well the left main coronary artery and we obtained diagnostic angiograms.

I then used a 6-French diagnostic right coronary catheter to engage the ostium of the right coronary artery and obtain diagnostic angiograms in the orthogonal and hemi axial views. We then attempted to place the guiding catheter in the left main coronary artery, and unfortunately, he has a very dilated aortic root and a very high takeoff of the left main coronary artery and high takeoff of the LAD.

I had to use several catheters until finally we successfully engaged a guiding catheter EBU to the left main coronary artery. Teh catherts employed were Ikari, several sizes, Tiger catheter. High takeoff catheter. Medtronic catheter___________.

We obtained the angiograms successfully. We injected intra-arterial verpamil, intra-arterial heparin, and intra-arterial nitroglycerin into the right radial artery.

We left the patient immediately to perform primary PCI to the 99% stenosis noted in the mid LAD below to the take over of a large septal perforator.

This procedure is dictated in a different report. The patient received conscious sedation and boluses of heparin during the procedure to achieve therapeutic ACT.

The patient had difficulties with cannulation and performance with the primary PCI preventing the performance of left venticular angiogram.


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## dpeoples (May 9, 2012)

Robbin109 said:


> RE: The cath, Would this just be 93454? What about the Aortic root? I don't see a seperate injection...or pressures in the left heart...thanks!!
> 
> *Procedure:*
> Cardiac Catheterization
> ...



I would code both the coronary angiography and the supravalvular angiography.
93454 (coronary angiography w/o LT or RT heart cath)
93567

You will probably need to add modifier 59 to 93454 due to the subsequent PCI.

HTH


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## Robbin109 (May 9, 2012)

Thanks!


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