# Lhc, no lv gram, ptca-lad, stents-lad



## dlsill (Jul 3, 2013)

Please help new to billing cath procedures
NOT SURE WHAT CODES TO USE. HELP

DATE:
,
•
HISTORY: This is a 78-year-old Afro-American male who is being referred for
primary angioplasty regarding an acute anteroseptal wall MI.

The patient is status post November 9, 2007, a 2.5 x 28 mm Mini vision stent
to the circumflex artery on November 9, 2007, status post April II, 2007 3.5 x
12 and 3.5 x 8 rom Taxus stent to the proximal mid LAD.
Status post October 26, 2011, 50% proximal LAD, 60% mid LAD.

PROCEDURE: Left heart catheterization from the right common femoral artery
approach.
Coronary angiography.
LV gram was not performed because creatinine is 1.85.
Thrombectomy of the left anterior descending artery utilizing a Medtronic
export catheter.
PTCA of the left anterior descending artery.
A 3.0 x 22 rom, 3.0 x 18 mm, 3.0 x 30 rom, 2.5 x 26 rom bare metal integrity
stent to the proximal mid and distal left- anterior descending artery.

DESCRIPTION: The above procedure was performed from the right common femoral
artery approach utilizing a Seldinger technique. A 6-French arterial sheath
was placed in the right common femoral artery. All catheter exchanges were
performed utilizing a 0.038 J-wire.
Coronary angiography was performed utilizing a 6-French CLS 3.5 guide and a 6-
French Williams right diagnostic catheter multiple projections.

CORONARY ANGIOGRAPHY: The right coronary artery is dominant.
off the right coronary cusp. There is a 50% ostial stenosis.
It originates
The stent to
the proximal right coronary artery is patent. Distal right coronary artery
and right posterior descending artery are normal.
The left main originates off the left coronary cusp and is normal.
The left anterior descending artery is
It was 0 TIMI flow. Circumflex artery
The second obtuse marginal is normal.
occluded in the AV groove.
100% occluded proximally to the stent.
reveals the obtuse marginal 1 is 50%.
Distal circumflex artery stent is 100%

A 0.014 moderate support and a 0.014 run-through wire was negotiated down the
left anterior descending artery.
Thrombectomy was performed with a Medtronic export catheter. This was
followed by peripheral angioplasty with a 2.5 x 20 rom Emerge balloon.
Distally the person who scrubbed with me inadvertently gave me instead of a
2.5 Emerge balloon, a 3.0 Emerge balloon. Inflation of 3.0 balloon was
performed at 2 to 4 atmospheres, which resulted in a dissection distally with
TIMI 0 flow.
Four stents were deployed from the proximal mid and distal LAD. A 3.0 x 22
rom, a 3.0 x 18 rom, a 3.0 x 30 rom, and 2.5 x 26 rom bare metal integrity stents,
or the 3.0 rom stents were post dilated with a 3.0 x 20 rom Trek balloon at 18
atmospheres. Final result, resulted in a 0% residual in the proximal mid and
distal LAD stents, put distal through the last stent there is TIMI 1 to 2
flow. Distally the vessel is diffusely diseased and small in size. I
determined not to put a more distal stent in because this would totally gel in
the vessel and prevent the patient ever having bypass surgery, but most likely
a graft could not be placed distally because the distal LAD is so diffusely
diseased. A total of 120 mL of Visipaque dye was utilized. Estimated blood
loss was less than 5 mL. Thrombus was removed through the export catheter.
Stat EKG was performed in the cath lab. On July I, 2013, at 3:35 that reveals
abnormal tracing showing sinus tachycardia, acute anterolateral wall MI, left
anterior hemiblock, nonspecific intraventricular conduction delay.

ASSESSMENT AND PLAN: The patient will be placed on aspirin 81 mg p.o. daily,
prasugrel 10 mg p.o. daily, Lopressor 12.5 mg p.o. b.i.d., ACE inhibitor, will
not be used because the creatinine is 1.85, Lipitor 80 mg p.o. nightly.
We will check a 20 echo with Doppler.

The patient's hemodynamics revealed a central aortic pressure of 110/80, left
ventricular pressure is 110/40. The patient is given 40 mg of IV Lasix in the
cath lab and will be placed on Lasix 40 mg IV q.12 hours, because the
creatinine is 1.85, he received IV fluid at a rate of 500 mL an hour in the
cath lab, which was then reduced to 10 mL an hour at the end of the case. The
patient tolerated the procedure well.


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## csorensen21@yahoo.com (Jul 3, 2013)

Can you attach the entire procedure note to accurately code this?


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## jewlz0879 (Jul 11, 2013)

I wouldn't use 92933 unless atherecomy was performed in addition to the stent and PTCA. 

It would be most helpful if you could post the report.


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## TWinsor (Jul 12, 2013)

What do you think about 

92941-LD (documentation states "acute MI")
93458-26-59


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## dls (Jul 18, 2013)

Thank you guys so much for the help


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