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Need help with these codes please; patient was admitted w/ STEMI and bradycardia & cardiogenic shock; not sure on the codes:
Based on findings at diagnostic catheterization,
intervention was undertaken on the right coronary artery. Angiomax
was administered and the right coronary was engaged with an XB-RCA
with side holes. I used a BMW Elite wire to cross through the
occlusion in the distal right and a 2.5 x 12 mm Trek balloon was
used to cross into the distal vessel. I then advanced a Fetch
manual aspiration thrombectomy catheter through the right coronary
artery and aspirated thrombus. I returned with a 2.5 x 12 mm
balloon and performed angioplasty on the proximal and mid right
coronary artery. I re-established TIMI-3 flow in the right
coronary artery and I was able to visualize the vessel that was
small in caliber and diffusely diseased. However, the most high
grade stenosis was the area of occlusion in the proximal to mid
right coronary artery. I covered this with a 2.5 x 33 mm Xience
drug-eluting stent. This was deployed with two inflations to 12
atmospheres. The distal edge of that stent still had some hazy
70-80% stenosis and the decision was made to cover this with a
2.25 x 12 mm Xience Expedition. This was deployed at 9
atmospheres and then the stent delivery balloon was withdrawn
slightly and inflated to 16 atmospheres. After removal of the
balloons and wires, we had TIMI-3 flow with no perforation,
dissection or distal embolization.
At this time, the decision was made to move the pacemaker to the
right IJ where it would be more stable. The patient was prepped
and draped in a sterile fashion and 2% Lidocaine was used to
infiltrate the skin overlying the right internal jugular vein
utilizing the modified Seldinger technique. Access was obtained
and a #5 French sheath was placed. I then advanced a second bard
pacing lead into the apex of the right ventricle. The pacemaker
was secured in place and the femoral pacemaker was removed. The
patient tolerated the procedure and had marked improvement in his
condition at the end.
93458,26, 59 92941 and for addtl access of pacer??
Thanks so much for any assistance, very much appreciated!
Based on findings at diagnostic catheterization,
intervention was undertaken on the right coronary artery. Angiomax
was administered and the right coronary was engaged with an XB-RCA
with side holes. I used a BMW Elite wire to cross through the
occlusion in the distal right and a 2.5 x 12 mm Trek balloon was
used to cross into the distal vessel. I then advanced a Fetch
manual aspiration thrombectomy catheter through the right coronary
artery and aspirated thrombus. I returned with a 2.5 x 12 mm
balloon and performed angioplasty on the proximal and mid right
coronary artery. I re-established TIMI-3 flow in the right
coronary artery and I was able to visualize the vessel that was
small in caliber and diffusely diseased. However, the most high
grade stenosis was the area of occlusion in the proximal to mid
right coronary artery. I covered this with a 2.5 x 33 mm Xience
drug-eluting stent. This was deployed with two inflations to 12
atmospheres. The distal edge of that stent still had some hazy
70-80% stenosis and the decision was made to cover this with a
2.25 x 12 mm Xience Expedition. This was deployed at 9
atmospheres and then the stent delivery balloon was withdrawn
slightly and inflated to 16 atmospheres. After removal of the
balloons and wires, we had TIMI-3 flow with no perforation,
dissection or distal embolization.
At this time, the decision was made to move the pacemaker to the
right IJ where it would be more stable. The patient was prepped
and draped in a sterile fashion and 2% Lidocaine was used to
infiltrate the skin overlying the right internal jugular vein
utilizing the modified Seldinger technique. Access was obtained
and a #5 French sheath was placed. I then advanced a second bard
pacing lead into the apex of the right ventricle. The pacemaker
was secured in place and the femoral pacemaker was removed. The
patient tolerated the procedure and had marked improvement in his
condition at the end.
93458,26, 59 92941 and for addtl access of pacer??
Thanks so much for any assistance, very much appreciated!