# Can 36245 be billed for Right Femoral Artery Angio



## Robbin109 (Aug 5, 2010)

PROCEDURE(S) PERFORMED:
1. Left and right heart catheterization.
2. Selective coronary angiography.
3. Left ventriculogram.
4. Fluoroscopy.
5. Right femoral artery angiogram.
6. 6-French Angio-Seal.

PROCEDURE:
After the informed consent was obtained, the patient was brought to the cardiac catheterization laboratory,
and prepped and draped in the usual sterile fashion. The right femoral area was anesthetized with 10 mL of
2% Xylocaine, and the right femoral artery was cannulated with a 6-French sheath using modified
Seldinger technique. The 6-French FL4, 6-French FR4, and 6-French pigtail catheters were used to obtain
multiple cineangiographic views of coronary anatomy, as well as left ventriculogram and hemodynamic
data measurements. The right femoral vein was then cannulated with an 8-French sheath, and a 7-French
Swan-Ganz catheter was used to cannulate the femoral vein and perform right heart catheterization. The
catheters were then withdrawn. Right femoral angiogram was performed, and a 6-French Angio-Seal was
used to obtain hemostasis. There were no complications. The patient was then transferred to his room in
stable condition.

HEMODYNAMICS:
The left ventricular pressure was 140/26 mmHg. There was no significant gradient across the aortic valve
on pullback. RIGHT HEART HEMODYNAMICS: The right atrial pressure was 4 mmHg, right ventricular
pressure is 32/5 mmHg. The pulmonary capillary wedge pressure mean was 10 mmHg with 15 mm
V-wave, and pulmonary artery pressure was 33/18 mmHg. The cardiac output was 3.3 L/minute bythermodilution, index was 1.7 L/minute per sq m.

CORONARY ANATOMY:
1. Left main coronary artery. The left main coronary artery originated from the left sinus of Valsalva
and was free of significant obstructive disease.
2. Left anterior descending coronary artery. The left anterior descending coronary artery originated
from the left main coronary artery. The vessel was tortuous without significant obstructive disease.
3. Left circumflex coronary artery. The left circumflex coronary artery originated from the left main
coronary artery. The vessel was mildly diffusely diseased without significant obstructive stenosis.
4. Right coronary artery. The right coronary artery originated from the right sinus of Valsalva and was
widely patent, dominant with mild diffuse disease.
5. Left ventriculogram. The left ventriculogram demonstrated a hyperdynamic left ventricular systolic
function with estimated ejection fraction of 70%, and 3 to 4+ mitral regurgitation.

IMPRESSION:
1. No significant obstructive coronary artery disease.
2. Hyperdynamic left ventricular systolic function with ejection fraction of 65% to 70%.
3. 3 to 4+ mitral regurgitation.
4. Moderately elevated left ventricular filling pressure and pulmonary artery pressure.


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## 10marty (Aug 5, 2010)

No it can not be billed.  It is part of the procedure.

Marty


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## dpeoples (Aug 6, 2010)

Heresmichelle said:


> PROCEDURE(S) PERFORMED:
> 1. Left and right heart catheterization.
> 2. Selective coronary angiography.
> 3. Left ventriculogram.
> ...




No. Access and closure of access is included with the procedure.

HTH


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