# 93459 + 92937



## amym (Jul 16, 2013)

Was this coded correctly?  93459-26-59 and 92937-RC?

-- CORONARY CIRCULATION: 
-- Graft to the distal circumflex: The graft was a large sized saphenous vein graft from the aorta. There was a 90 % stenosis at the graft ostium. 

PROCEDURES PERFORMED: 

-- Left coronary angiography. 
-- Right coronary angiography. 
-- LIMA graft angiography. 
-- Saphenous vein graft angiography. 
-- LIMA graft angiography. 
-- Coronary Drug Eluding Stent Placement. 
-- PTCA. 

INDICATIONS: Angina/MI: myocardial infarction without ST elevation 
(NSTEMI). 

VENTRICLES: There were no left ventricular global or regional wall motion abnormalities. 

CORONARY VESSELS: Left main: Normal. LAD: There was a 100 % stenosis in the proximal third of the vessel segment. Distal LAD: There was a 95 % stenosis. In a second lesion, there was a 70 % stenosis. Proximal circumflex: Angiography showed moderate atherosclerosis. Distal circumflex: Angiography showed multiple discrete lesions. RCA: There was a 100 % stenosis. distal vessel filled by bridging collaterals Distal vessel angiography showed a medium sized vessel and moderate diffuse disease. 
Graft to the LAD: The graft was a LIMA. Graft angiography showed no evidence of disease. Graft to the distal circumflex: The graft was a large sized saphenous vein graft from the aorta. There was a 90 % stenosis at the graft ostium. Graft to the RCA: The graft was a saphenous vein graft from the aorta. There was a 100 % stenosis at the graft ostium. 

PROCEDURE: The risks and alternatives of the procedures and conscious sedation were explained to the patient and informed consent was obtained. The patient was brought to the cath lab and placed on the table. The planned puncture sites were prepped and draped in the usual sterile fashion. 

-- Right femoral artery access. The puncture site was infiltrated with local anesthetic. The vessel was accessed using the modified Seldinger technique, a wire was threaded into the vessel, and a sheath was advanced over the wire into the vessel. 

-- Left coronary artery angiography. A catheter was advanced to the aorta and positioned in the vessel ostium under fluoroscopic guidance. Angiography was performed in multiple projections using hand-injection of contrast. 

-- Right coronary artery angiography. A catheter was advanced to the aorta and positioned in the vessel ostium under fluoroscopic guidance. Angiography was performed in multiple projections using hand-injection of contrast. 

-- Left internal mammary graft angiography. A catheter was advanced to the aorta and positioned at the aortic anastomosis of the graft under fluoroscopic guidance. Angiography was performed in multiple projections using hand-injection of contrast. 

-- Saphenous vein graft angiography. A catheter was advanced to the aorta and positioned at the aortic anastomosis of the graft under fluoroscopic guidance. Angiography was performed in multiple projections using hand-injection of contrast. 

-- Left internal mammary graft angiography. A catheter was advanced to the aorta and positioned at the aortic anastomosis of the graft under fluoroscopic guidance. Angiography was performed in multiple projections using hand-injection of contrast. 

LESION INTERVENTION: 

-- Balloon angioplasty was performed, using a Emerge Rx 3.0 x 15mm balloon, with 3 inflations and a maximum inflation pressure of 10 atm. 

-- A Resolute Integrity Rx 3.00 x 18mm drug-eluting stent at a maximum inflation pressure of 12 atm. 

-- , using a NC Quantum 3.0 x 8 balloon, with 1 inflations and a maximum inflation pressure of 15 atm. 

CARDIAC INTERVENTIONS 
-- Coronary Drug Eluding Stent Placement. 

-- PTCA. 

COMPLICATIONS: 
None occurred during the cath lab visit. 

STUDY DIAGRAM 

Angiographic findings 
Native coronary lesions: 
7LAD: Lesion 1: 100 % stenosis. 
7Distal LAD: Lesion 1: 95 % stenosis. Lesion 2: 70 % stenosis. 
7RCA: Lesion 1: 100 % stenosis. 

Coronary graft lesions: 
7Graft to distal circumflex: SVG 7 90 % stenosis at graft ostium. 

7Graft to RCA: SVG 7 100 % stenosis at graft ostium. 

HEMODYNAMIC TABLES 

Pressures: Baseline 
Pressures: - HR: 73 
Pressures: - Rhythm: 
Pressures: -- Aortic Pressure (S/D/M): 107/57/75 
Pressures: -- Left Ventricle (s/edp): 104/6/-- 

Outputs: Baseline 
Outputs: -- CALCULATIONS: Age in years: 57.17 
Outputs: -- CALCULATIONS: Body Surface Area: 2.04 
Outputs: -- CALCULATIONS: Height in cm: 191.00 
Outputs: -- CALCULATIONS: Sex: Male 
Outputs: -- CALCULATIONS: Weight in kg: 76.20


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## jewlz0879 (Jul 25, 2013)

I agree with the codes. 

HTH


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