# Selective right iliofemoral angiogram?



## Robbin109 (Nov 20, 2010)

Can someone please tell me how to code for the selective right iliofemoral angiogram? 

A 73-year-old white male with known coronary artery disease, status post stent in distal RCA, who had

increased frequent episodes of PVCs. Nuclear stress test shows a fixed defect in the inferolateral wall,

suggesting MI or hibernation. Coronary angiogram was performed to evaluate coronary anatomy and to

guide further treatment.

PROCEDURE PERFORMED:

1. Left heart catheterization.

2. LV ventriculogram.

3. Selective right iliofemoral angiogram.

DESCRIPTION OF PROCEDURE:

After informed witnessed and written consent, the patient was given Versed a total of 100 mcg

intravenously. The right coronary artery was engaged using a modified Seldinger technique, after local

anesthesia with 1% lidocaine. Left and right coronary artery were induced using a multipurpose A2

catheter. LV ventriculogram was performed using multipurpose A2 catheter. Selective right iliofemoral

angiogram was also performed. There were no complications. Total fluoroscopy time was 3 minutes.

HEMODYNAMICS:

1. Aortic pressure 135/69, LV pressure 136. There was no pressure gradient across aortic valve.

LVEDP 12.

2. Left main gives rise to LAD and circumflex. Left main is a large caliber vessel that has luminal

irregularities. LAD gives rise to three diagonal branches. LAD has luminal irregularities. Diagonal

branch has nonobstructive coronary artery disease. Left circumflex is slightly ectatic and gives rise to

two OM branches, and has luminal irregularities.

3. RCA is dominant. RCA gives rise to PDA and PLV branch. Proximal RCA has 20% stenosis.

Proximal to mid RCA is ectatic. Mid RCA has 60% eccentric stenosis. The stent in RCA appears to be

patent, with about 20% in-stent stenosis. PLV and PDA branch have luminal irregularities.

4. LV ventriculogram shows LVEF is 65%. No regional wall motion abnormality. No diastolic

dysfunction.

5. Selective right iliofemoral branch showed no atherosclerotic plaque. There appears to be high

bifurcation.
CONCLUSION:

Patent stent in the distal RCA, eccentric 60% stenosis in the mid RCA: Would recommend FFR to evaluate

the hemodynamic significance of this stenosis and to further guide treatment.


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## Cyndi113 (Nov 22, 2010)

Good morning, 

Is this the complete report? Where was the initial stick/puncture done? Also what was the med necessity for the leg angiogram?


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## Robbin109 (Nov 22, 2010)

Yes, this is the complete report.


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## Robbin109 (Nov 22, 2010)

*here's another one*

INDICATION FOR STUDY:
A 68-year-old white male who had a history of hypercholesterolemia, light smoker, who came in with
exertional angina. Troponin mildly elevated at 0.37, at borderline. Coronary angiogram was performed to
evaluate coronary anatomy and to guide treatment.
PROCEDURE PERFORMED:
1. Left heart catheterization.
2. LV ventriculogram.
3. Selective right iliofemoral angiogram.
PROCEDURE:
After informed witnessed and written consent, the patient was given Versed, a total of 2 mg, and fentanyl,
a total of 50 mcg intravenously. The right groin was draped and prepped by the usual manner. The right
femoral artery was accessed using modified Seldinger technique after local anesthesia with 1% lidocaine.
Left and right coronary arteries were engaged using multipurpose A2 catheter. LV ventriculogram was
performed using multipurpose A2 catheter. Selective right iliofemoral angiogram was also performed
before the placement of Angio-Seal. Total fluoro time was 3.3 minutes.
HEMODYNAMICS:
1. Aortic pressure 121/69, LV systolic pressure 121. LVEDP 13. There was no pressure gradient
across the aortic valve.
2. Left main gives rise to LAD and circumflex. Left main is normal. LAD gives rise to a big diagonal
branch. Proximal LAD has 50% stenosis. The mid LAD after the first diagonal has 40% stenosis. Left
circumflex is dominant. Left circumflex gives rise to OM1, OM2, OM2, 3 and PLOM/OM4. Mid
circumflex immediately before the ostium of OM2/MOM has 90% to 95% stenosis. OM1 is a small
vessel and is chronic total occlusion with left-to-left collateralization OM2/MOM has luminal
irregularities. OM3 is a small vessel and is normal. PLOM has luminal irregularities.
3. RCA is a small vessel. Proximally, has luminal irregularities. Distal RCA, before the bifurcation,
has 50% stenosis.
4. LV ventricle shows EF 60% to 65%. No significant regional wall motion abnormality. No significant mitral regurgitation.
5. Selective right iliofemoral angiogram shows patent right iliac artery and right common femoral
artery, proximal superficial femoral artery have minimal plaques.
CONCLUSION:90% to 95% stenosis in mid circumflex. Will recommend PCI, stent by


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## Jim Pawloski (Nov 22, 2010)

WorldWalker said:


> INDICATION FOR STUDY:
> A 68-year-old white male who had a history of hypercholesterolemia, light smoker, who came in with
> exertional angina. Troponin mildly elevated at 0.37, at borderline. Coronary angiogram was performed to
> evaluate coronary anatomy and to guide treatment.
> ...



The femoral angiogram is part of the angioseal closure device.  It is not billable.

Thanks,
Jim Pawloski


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## theresa.dix@tennova.com (Nov 22, 2010)

Jim is right.


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