# Ptca w/ivus



## dlsill (Jul 11, 2013)

Would I code both 93458-26,59 ---92920-LD and 92978 

This is a 67-year-old white female being referred for cardiac catheterization
and possible intervention regarding unstable angina, failing medical therapy.
The patient is status post stent to her left anterior descending artery in the
past.
PROCEDURE:
1. Left heart catheterization from the right radial artery approach.
2. Coronary angiography.
3. Left ventriculogram.
4. Intravascular ultrasound of the left anterior descending artery utilizing
a 40 megahertz Boston Scientific Atlantis catheter.
5. PTCA of the left anterior descending artery by intravascular ultrasound
guidance with a 3.5 x 12 noncompliant Quantum balloon.
6. Monitored anesthesia care.

DESCRIPTION: The above procedures were performed from the right radial artery
approach utilizing Seldinger technique. A 0.020 needle was inserted in the
right radial artery. A 0.018 Terumo wire was advanced into the right radial
artery. A 6-French arterial sheath placed. The patient was administered 2500
units of intraarterial heparin and 3 mg of intraarterial verapamil.
All catheter exchanges were performed utilizing a 0.035 Rosen wire.
A 5-French pigtail catheter was inserted across the aortic valve. Left
ventricular end diastolic pressure was measured. LV gram was performed in the
RAO projection utilizing 32 mL of Visipaque dye in dye injection at the rate
of 10 mL per second. Following LV gram, left ventricular end diastolic
pressure was remeasured and pigtail pullback was performed.
LV gram revealed a left ventricular ejection fraction of 60%. There is normal
motion of the anterior base, anterolateral wall, apex, diaphragmatic wall,
inferior base. No mitral regurgitation or mitral valve prolapse.
Coronary angiography was performed utilizing as-French TIG catheter in
multiple projections.

The left main originates off the left coronary cusp and is normal.
The circumflex artery consists of an obtuse marginal 1 and 2.
The left anterior descending artery reveals an in-stent stenosis distally of
approximately 70%. Please refer to the intravascular ultrasound below. First
and second diagonal is normal.

The right coronary artery is codominant.
A 6-French CLS3.5 guide engaged the left main. A 0.014 run through wire was
negotiated down and then utilizing a Boston Scientific 40 megahertz
Atlantis catheter, intravascular ultrasound of the left anterior descending
artery was performed which revealed an in-stent stenosis of the distal aspect
of the left anterior descending artery measuring 3.51 rom2 with proximal
reference diameter segment of 3.4 x 3.6 mm and distal reference diameter
segment of 3.3 x 3.3 rom.
Angioplasty of the stenosis of the LAD was performed. Activated coagUlation
time was greater than 400 seconds with a 3.5 x 12 mm noncompliant Quantum
balloon at 20 atmospheres. Final result revealed a 0% residual. Repeat
intravascular ultrasound revealed a good stenosis apposition with a cross
sectional area of the lumen of 6.29 mm2 with a diameter of 2.6. The patient
tolerated the procedure well. There were no complication.
Total contrast dye was 190 mL of Visipaque dye. Estimated blood loss
Complications none.

ASSESSMENT AND PLAN: The patient will be discharged on 07/02/2013 to followup
MEDICATIONS: Aspirin 81
weeks. I did not deploy
day and lisinopril 5 mg.
mg p.o. daily, prasugrel 10 mg p.o. daily for six
vytorin 10/40 one p.o. daily, Toprol 50 mg a
Cardiac scripts are on the chart.


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## Jess1125 (Jul 11, 2013)

dlsill said:


> Would I code both 93458-26,59 ---92920-LD and 92978
> 
> This is a 67-year-old white female being referred for cardiac catheterization
> and possible intervention regarding unstable angina, failing medical therapy.
> ...



All codes look good to me. 
Jessica CPC, CCC


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