# Stent same vessel



## csorensen21@yahoo.com (Aug 16, 2013)

Any help on coding this procedure would be much appreciated. I am unsure where to start and if you are able to code for two stents here. Thank you.

Indications: 
Angina Pectoris yes
Positive stress test no 
MI STEMI no
MI NONSTEMI no
Large reversible ischemia w/myocardial perfusion/echo imaging no
High surgical risk for CABG yes

Procedure Details:
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was brought to the cath lab after IV hydration was begun and oral premedication was given. Patient was prepped and draped in the usual manner. Using the modified Seldinger access technique, a 6 French sheath was placed in the femoral artery.  AR1 catheter was used to engage with the saphenous vein graft to the right and an AL1 catheter was used to engage with the saphenous vein graft to the diagonal artery.  Then, we used an AR1 guiding catheter that engaged with the saphenous vein graft to the right.  Filter wire was advanced without any immediate problem and a 4.0 x 15 Xience Expedition stent was deployed at 14 atmospheres, abolishing an 85% lesion down to 0 and maintain TIMI 3 flow pre and post with 0 residue and then the filter was retrieved and we used an AL1 guiding catheter engaged with the saphenous vein graft to the diagonal artery.  BMW universal wire was advanced and then we attempted to advance the stent, but it was not advanced above across a tight region and the diagonal artery, so we used a 2.0 balloon to predilate the lesion followed by a 2.75 x 15 Xience V stent that was deployed at 14 atmospheres, abolishing a 90% lesion down to 0, maintaining TIMI 3 flow pre and post and 0 residue.  The patient tolerated the procedure well without any immediate problem.  Sheath was removed and then Angio-Seal deployed after confirming mid femoral artery access.. Family were notified with the results.


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## TWinsor (Aug 21, 2013)

I see a 92937 for the PCI through the SVG to the diagonal.  I am not sure what is meant by "saphenous vein graft to the right".  Is this a separate graft to the RCA or is the physician referring to the an additional branch?


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## Jim Pawloski (Aug 21, 2013)

csorensen21@yahoo.com said:


> Any help on coding this procedure would be much appreciated. I am unsure where to start and if you are able to code for two stents here. Thank you.
> 
> Indications:
> Angina Pectoris yes
> ...



I read it as two separate bypass grafts.  I would use 92937-RC and 92973-LD (C9604-RC and C9604-LD for Medicare)
HTH,
Jim Pawloski, CIRCC


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