# Attempted angioplasty diagonal and implantation stent mid lad + right iliac angio



## pamsridharan (Sep 11, 2012)

Need assistance pls!!

Is it correct to code as follows based on the op-report below?

93458-2659
92982-(52 or 53?)
92980-59
G0278

PROCEDURE PERFORMED:
1. Left heart catheterization.
2. Selective coronary angiography.
3. Percutaneous intervention with attempted angioplasty of the
    diagonal and implantation of a 3.0 x 12 mm Xience stent in the mid
    LAD, as well as right iliac angiography.

DESCRIPTION OF PROCEDURE:  The right groin was prepped and draped in the
usual sterile fashion.  Xylocaine 1% was used to infiltrate the area for
local anesthesia.  A #6-French sheath was placed in right femoral artery
using a single puncture modified Seldinger technique.  A JL4 was engaged
in the left coronary ostium.  Contrast material was injected and views
were obtained.  A JR4 was engaged in the right coronary ostium.
Contrast material was injected and views were obtained.  Catheters were
removed and the patient remained on the table in anticipation of review
of the films and a possible intervention.

SELECTIVE RIGHT AND LEFT CORONARY ANGIOGRAPHY:  The left coronary system
was seen to originate from its normal anatomic position in the left
sinus of Valsalva.  The left main coronary artery was normal.  The LAD
was noted to have mild plaquing.  There was an eccentric plaque noted in
the mid-LAD just before the takeoff of a subtotally occluded diagonal
branch which appeared very tortuous at its origin.

The coronaries had some mild calcifications. The left circumflex
coronary artery had mild plaquing.  The right coronary artery was seen
to originate from its normal anatomic position in the right sinus of
Valsalva.  This vessel was noted to have very mild plaquing as well.

In view of the patient's symptoms and imagined perfusion defects,
attempted angioplasty of the diagonal was made as described below.

The patient was given 5000 units of heparin. Left coronary system was
engaged with an XB LAD 3.5 guide catheter.  Attempts at crossing the
diagonal with a Fielder ET and Pilot 50, as well as a balanced track
wire was unsuccessful.  Even with support of a FineCross catheter.
After multiple attempts it was noted that the plaque that was just
proximal seemed to takeoff of the diagonal was disrupted and in order to
avoid a possible acute occlusion, the LAD was wired with a Pilot wire
and a 30 x 12 mm Xience was placed and deployed with an inflation of 16
atmospheres for 15 seconds.  Final angiography revealed the same.
Closing pressures were then measured and right iliac angiography was
performed.  Introducer sheath was removed and Angio-Seal closure device
was deployed successfully.  Please note that the final angiography after
multiple doses of intracoronary nitroglycerin revealed a widely patent
LAD with a totally occluded diagonal coronary artery with collaterals
from the left.


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