# heart cath &  selective renal?



## maryann1224@bellsouth.net (Jun 12, 2015)

Need assistance for left heart cath w/ renal angiography, etc
Thank you for any help.
93458 26 59 (lhc)
36251 (renal?)
92928 RC... 



LHC/CORONARIES W/WO LV GRAM
  STENT (BMS OR DES) RC (COR)
  Left subclavian angiography- EXTREMITY, UNILATERAL RT (SELECTIVE)
  Right subclavian angiography- nonselective
  ABDOMINAL AORTOGRAM
  RENAL ANGIOGRAPHY, UNILATERAL RT
  Clinical History & Appropriate Use
  67-year-old with history of coronary stenting admitted with angina 
pectoris in the pattern consistent with class IV 
 angina.  She had severe central hypertension with marked discrepancy in 
the left upper extremity blood pressure prompting left 
 subclavian angiography.  I also had difficulty advancing the catheters 
through the right subclavian prompting right subclavian 
 angiography.  After finding severe peripheral arterial disease who 
presents for severe hypertension, abdominal aortography was 
 performed to assess renovascular hypertension.
    Diagnostic Procedure Details
  . 
 The patient was prepped and draped in the standard manner. 2% lidocaine 
was used for local anesthesia over the right radial 
 artery. The radial artery was accessed with a micro puncture needle and a 
5 Fr glide sheath advanced using and over the wire 
 technique. Bilateral selective coronary angiography was performed with a 
Tig catheter. Left heart catheterization and LV 
 angiography was performed with a Tig catheter. 

 A JL 3.5 catheter was advanced from the right radial artery and to the 
aortic arch and used to selectively engage the left 
 subclavian artery.  Angiography was performed.  The jail catheter was 
exchanged for a pigtail catheter was advanced into the 
 descending aorta at the level of the renal arteries and an abdominal 
aortogram was performed.  We then selectively engaged the 
 right renal artery with a multipurpose catheter and repeated angiography 
of the right renal artery.  Intervention was performed 
 on the right coronary artery as described below.  Nonselective 
angiography of the right subclavian artery was performed 
 utilizing the interventional guide catheter which was withdrawn from the 
right coronary artery into the brachiocephalic artery 
 where angiography was performed. Based on findings of diagnostic catheterization, intervention was 
undertaken on the RCA.
  Prior to intervention, the flow in the target vessel was TIMI 3.
  Angiomax was used for anticoagulation.
  The guide used was a 6 French Mac 3.0 guide catheter.
  The lesion was wired with a Runthrough 0.014 guidewire.
  The lesion was pre-treated with a  Medtronic Sprinter RX 1.5mmX 10mm 
balloon followed by a Abbott Trek RX 3.0mmX 20mm 
 balloon.
  The lesion was stented with a Abbott Xience Alpine 3.5mmX 23mm
  Following the intervention, there was no residual stenosis and TIMI-3 
flow.
  Final angiography demonstrated no perforation, dissection or distal 
embolization.
  Peripheral Vascular
  Angiography at the level of the renal arteries demonstrates a probable 
high-grade stenosis in the right renal artery.  Due to 
 extreme tortuosity coming from the right radial artery, it was difficult 
to directly engage the origin of the right coronary artery 
 with a multipurpose catheter.  Angiography did suggest high-grade 
stenosis and further evaluation by renal duplex ultrasound 
 is recommended.

 The left subclavian artery was selectively engaged and angiography 
demonstrated occlusion of the left subclavian artery 
 proximal to the left vertebral artery.

 The right subclavian artery was found to have an eccentric calcified 
stenosis of at least 70%.  There was a 20 mm gradient on 
 pullback across that stenosis in the right upper extremity.


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## Jim Pawloski (Jun 12, 2015)

maryann1224@bellsouth.net said:


> Need assistance for left heart cath w/ renal angiography, etc
> Thank you for any help.
> 93458 26 59 (lhc)
> 36251 (renal?)
> ...



You need to add 36215 and 75710 for the lt subclavian artery injection. Everything else looks fine, if you are billing for the physician.
Thanks,
Jim Pawloski, CIRCC


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## maryann1224@bellsouth.net (Jun 17, 2015)

oh got it now, thank you so much!


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