# PCI Total Occlusion



## amym (Jun 24, 2013)

Would this note qualify for billing a 92941 or 92943 or it's just a 92928? Thanks

-- CORONARY CIRCULATION: 
-- Mid LAD: There was a diffuse 100 % stenosis. There was good collateral 
blood supply to the distal myocardium. This lesion is a chronic total 
occlusion. 

-- 1ST LESION INTERVENTIONS: 
-- A drug-eluting stent was performed on the 100 % lesion in the proximal 
LAD. -- A PE Plus MR 2.5 x 20 drug-eluting stent was placed across the 
lesion and deployed at a maximum inflation pressure of 15 atm. 

PROCEDURES PERFORMED: 

-- Coronary Drug Eluding Stent Placement. 
-- Interventional OCT. 
-- Intervention on proximal LAD: . 

INDICATIONS: Angina/MI: stable angina. 

HEMODYNAMICS: Hemodynamic assessment demonstrates normal hemodynamics. 

CORONARY VESSELS: The coronary circulation is right dominant. Proximal 
LAD: There was a 100 % stenosis. There was TIMI grade 0 flow through the 
vessel (no flow). Mid LAD: There was a diffuse 100 % stenosis. There was 
good collateral blood supply to the distal myocardium. This lesion is a 
chronic total occlusion. 

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 radial 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 catheter was 
advanced over the wire into the vessel. 

LESION INTERVENTION: A drug-eluting stent was performed on the 100 % 
lesion in the proximal LAD. This was an ACC/AHA type C "high risk" lesion 
for intervention. There was TIMI 0 flow before the procedure. There was no 
acute vessel closure. There was no perforation. There was no dissection. 

-- Vessel setup was performed. A BMW HT 190cm wire was used to cross the 
lesion. 

-- Vessel setup was performed. A Runway 6FR LBU 3.5 guiding catheter was 
used to cannulate the vessel. 

-- Balloon angioplasty was performed, using a Sprinter 1.25 X 12 balloon, 
with 2 inflations and a maximum inflation pressure of 15 atm. 

-- Balloon angioplasty was performed, using a Apex Push 1.5 x 12 balloon, 
with 3 inflations and a maximum inflation pressure of 15 atm. 

-- A PE Plus MR 2.50 x 32 drug-eluting stent placement was attempted, but 
would not cross the lesion and was removed at a maximum inflation pressure 
of 14 atm. 

-- Balloon angioplasty was performed, using a Emerge Rx 2.25 x 15mm 
balloon, with 4 inflations and a maximum inflation pressure of 15 atm. 

-- A PE Plus MR 2.5 x 20 drug-eluting stent was placed across the lesion 
and deployed at a maximum inflation pressure of 15 atm. 

-- Balloon angioplasty was performed, using a NC Quantum 3.0 x 12 
balloon, with 4 inflations and a maximum inflation pressure of 17 atm. 

-- An OCT, using a Dragonfly Pressure Kit. 

CARDIAC INTERVENTIONS 
-- Coronary Drug Eluding Stent Placement. 

-- Interventional OCT


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## CPCCODERII (Jun 25, 2013)

In looking at your documentation it states the 100% stenosis is a chronic total occlusion, so based on that you would not be able to bill the 99241.  You could however bill the 92943, that seems appropriate based on documentation.  HTH


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## amym (Jun 28, 2013)

Thanks a lot


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