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Need assistance w/ the correct stenting codes on this, patient admitted w/ 410.90 (MI), not certain of stenting codes to use? Thank you.
PCI Details
Patient arrived in the Cath Lab in respiratory distress and was placed on BiPAP and IV Lasix was administered.. Given the inferior ST
segment changes and initially addressed the right coronary artery. A 6 French MAC 3.0 x 30 mm guide catheter was used to
engage the right coronary artery. The right coronary artery was totally occluded and we could not determine angiographically if
this was a thrombotic occlusion or a chronic total occlusion. We therefore probed the lesion with both a Runthrough wire and a
Whisper wire and determined that this was not the culprit lesion but a chronic total occlusion. I therfore did not attempt to
open the vessel. Instead we determined that the circumflex artery and the left anterior descending artery with a culprit lesions
causing inferior infarct because of compromised collaterals to the totally occluded right coronary artery.
Attention was turned to the left circumflex artery. Angiomax had previously been administered and the left main was engaged
with an EBU 3.75 6 French guide catheter with side holes. The run through wire was advanced into the large first Obtuse
Marginal vessel. Angioplasty was performed with a 2.5 x 12 mm balloon. The circumflex artery was then stented with a 3.0 x 12
mm Vision bare-metal stent. Attention was then turned to the lesion in the ostial proximal LAD. The run through wire was
advanced into the distal LAD. I then direct stented the LAD with a 2.5 x 12 mm Xience stent deployed at 12 atmospheres. After
angioplasty of the LAD, we returned to the circumflex artery with the same Runthrough wire. There was a haziness with a stent
at that time if this was calcium or thrombus. Therefore against infection 2 aspiration thrombectomy catheter into the circumflex
artery. There is no improvement in appearance and therefore performed high pressure angioplasty with an 3 X 8 mm balloon on
the stented region. After removal balloons and wires there remains to be 3 flow down the LAD and circumflex artery with no
perforation dissection or distal embolization. The TR band was applied to the right radial artery with adequate achievement
hemostasis.
PCI Details
Patient arrived in the Cath Lab in respiratory distress and was placed on BiPAP and IV Lasix was administered.. Given the inferior ST
segment changes and initially addressed the right coronary artery. A 6 French MAC 3.0 x 30 mm guide catheter was used to
engage the right coronary artery. The right coronary artery was totally occluded and we could not determine angiographically if
this was a thrombotic occlusion or a chronic total occlusion. We therefore probed the lesion with both a Runthrough wire and a
Whisper wire and determined that this was not the culprit lesion but a chronic total occlusion. I therfore did not attempt to
open the vessel. Instead we determined that the circumflex artery and the left anterior descending artery with a culprit lesions
causing inferior infarct because of compromised collaterals to the totally occluded right coronary artery.
Attention was turned to the left circumflex artery. Angiomax had previously been administered and the left main was engaged
with an EBU 3.75 6 French guide catheter with side holes. The run through wire was advanced into the large first Obtuse
Marginal vessel. Angioplasty was performed with a 2.5 x 12 mm balloon. The circumflex artery was then stented with a 3.0 x 12
mm Vision bare-metal stent. Attention was then turned to the lesion in the ostial proximal LAD. The run through wire was
advanced into the distal LAD. I then direct stented the LAD with a 2.5 x 12 mm Xience stent deployed at 12 atmospheres. After
angioplasty of the LAD, we returned to the circumflex artery with the same Runthrough wire. There was a haziness with a stent
at that time if this was calcium or thrombus. Therefore against infection 2 aspiration thrombectomy catheter into the circumflex
artery. There is no improvement in appearance and therefore performed high pressure angioplasty with an 3 X 8 mm balloon on
the stented region. After removal balloons and wires there remains to be 3 flow down the LAD and circumflex artery with no
perforation dissection or distal embolization. The TR band was applied to the right radial artery with adequate achievement
hemostasis.
