shescka
Contributor
Hello,
I'm new in cardiology and my understanding is that when left heart cath is done, the cath has to pass the aortic valve. Once it is inside the left ventricle of the pt's heart. Inside the ventricle it is where the pressure measurements and or ventriculogram are taken.
If the LVEDP is not taken like in this example below, should still use 93458?
This is how I coded : 92943, 93458,26,59
thank you in advance for your time
BRIEF HISTORY:
This is a 53-year-old male with a history of HIV, hypertension,
smoking with questionable medical compliance with medications, who
presented with complaints of intermittent chest pressure for the last
24 hours that woke him up early in the morning, at which time he
presented to the ER with an EKG showing inferior ST elevations with Q-
waves along with CTS class 4 angina for which he was referred for an
emergent left heart catheterization.
DESCRIPTION OF PROCEDURE:
After informed consent was obtained, both groins were prepped and
draped in a sterile fashion and using the mini stick, right femoral
arterial access was attempted, but the micropuncture wire did not pass
freely into the femoral artery due to which the 6-French MS sheath was
placed in the left femoral artery, and angiogram confirmed normal
sheath positioning, after which a 6-French JL4 catheter was used to
obtain left coronary angiography followed by a 6-French JR4 guide
catheter used to obtain right coronary angiography. A thrombotic
occlusion was noted in the mid LAD at which time, we prepared for PCI
to the LAD. IV Angiomax was administered to maintain adequate
anticoagulation. After attempting to cross the mid RCA lesion with a
long Prowater wire unsuccessfully, we then across the mid-LAD lesion
with a 300 cm PT 2 wire over a FineCross after which a Pronto LP was
used to perform aspiration thrombectomy of the mid to distal RCA. A
double bolus of IV Integrilin was administered due to the high
thrombotic burden and it was confirmed that the Pronto catheter did
extract a small amount of clot from the RCA. We then pre-dilated the
mid RCA lesion with a 2.5 x 12 mm Emerge compliant balloon to 12
atmospheres after which Pronto LP aspiration thrombectomy was again
performed. This restored flow in the RCA. We then exchanged the PT 2
wire for a long Prowater wire over a FineCross and a 5-French MS
sheath was placed in the left femoral vein in case the patient needed
a temporary pacemaker during the PCI. We then successfully deployed at
3.0 x 12 mm Rebel bare metal stent in the mid RCA to 12 atmospheres
after which we post dilated the stent with a 3.25 x 12 mm NC balloon
in its proximal to mid section to 14 atmospheres. This gave a
favorable angiographic result with good stent apposition and no
evidence of dissection. There was TIMI 0 flow in the distal RCA prior
to the PCI and TIMI-3 flow in the distal RCA post PCI. The mid RCA
lesion was 100 percent occluded prior to the PCI and 0 percent
residual stenosis post PCI. There was a small amount of thrombus
embolized in the very distal right coronary artery, which we did not
intervene on as there was TIMI-3 flow in the distal RCA beyond this
thrombus. A 6-French Angio-Seal was then successfully deployed in the
left femoral artery to achieve hemostasis. There were no complications
during the procedure and the patient tolerated the procedure well.
ANGIOGRAPHIC FINDINGS:
1. Left main with no angiographic stenosis.
2. Mid LAD has a mild up to 30 percent focal stenosis.
3. Left circumflex has no angiographic stenosis.
4. Right coronary artery has a mid segment thrombotic total occlusion.
5. Dominance: Codominant.
POSTOPERATIVE DIAGNOSIS:
Successful PCI to the mid RCA with a 3.0 x 24 mm Rebel bare metal
stent post dilated to 3.25 mm after successful Pronto aspiration
thrombectomy.
I'm new in cardiology and my understanding is that when left heart cath is done, the cath has to pass the aortic valve. Once it is inside the left ventricle of the pt's heart. Inside the ventricle it is where the pressure measurements and or ventriculogram are taken.
If the LVEDP is not taken like in this example below, should still use 93458?
This is how I coded : 92943, 93458,26,59
thank you in advance for your time
BRIEF HISTORY:
This is a 53-year-old male with a history of HIV, hypertension,
smoking with questionable medical compliance with medications, who
presented with complaints of intermittent chest pressure for the last
24 hours that woke him up early in the morning, at which time he
presented to the ER with an EKG showing inferior ST elevations with Q-
waves along with CTS class 4 angina for which he was referred for an
emergent left heart catheterization.
DESCRIPTION OF PROCEDURE:
After informed consent was obtained, both groins were prepped and
draped in a sterile fashion and using the mini stick, right femoral
arterial access was attempted, but the micropuncture wire did not pass
freely into the femoral artery due to which the 6-French MS sheath was
placed in the left femoral artery, and angiogram confirmed normal
sheath positioning, after which a 6-French JL4 catheter was used to
obtain left coronary angiography followed by a 6-French JR4 guide
catheter used to obtain right coronary angiography. A thrombotic
occlusion was noted in the mid LAD at which time, we prepared for PCI
to the LAD. IV Angiomax was administered to maintain adequate
anticoagulation. After attempting to cross the mid RCA lesion with a
long Prowater wire unsuccessfully, we then across the mid-LAD lesion
with a 300 cm PT 2 wire over a FineCross after which a Pronto LP was
used to perform aspiration thrombectomy of the mid to distal RCA. A
double bolus of IV Integrilin was administered due to the high
thrombotic burden and it was confirmed that the Pronto catheter did
extract a small amount of clot from the RCA. We then pre-dilated the
mid RCA lesion with a 2.5 x 12 mm Emerge compliant balloon to 12
atmospheres after which Pronto LP aspiration thrombectomy was again
performed. This restored flow in the RCA. We then exchanged the PT 2
wire for a long Prowater wire over a FineCross and a 5-French MS
sheath was placed in the left femoral vein in case the patient needed
a temporary pacemaker during the PCI. We then successfully deployed at
3.0 x 12 mm Rebel bare metal stent in the mid RCA to 12 atmospheres
after which we post dilated the stent with a 3.25 x 12 mm NC balloon
in its proximal to mid section to 14 atmospheres. This gave a
favorable angiographic result with good stent apposition and no
evidence of dissection. There was TIMI 0 flow in the distal RCA prior
to the PCI and TIMI-3 flow in the distal RCA post PCI. The mid RCA
lesion was 100 percent occluded prior to the PCI and 0 percent
residual stenosis post PCI. There was a small amount of thrombus
embolized in the very distal right coronary artery, which we did not
intervene on as there was TIMI-3 flow in the distal RCA beyond this
thrombus. A 6-French Angio-Seal was then successfully deployed in the
left femoral artery to achieve hemostasis. There were no complications
during the procedure and the patient tolerated the procedure well.
ANGIOGRAPHIC FINDINGS:
1. Left main with no angiographic stenosis.
2. Mid LAD has a mild up to 30 percent focal stenosis.
3. Left circumflex has no angiographic stenosis.
4. Right coronary artery has a mid segment thrombotic total occlusion.
5. Dominance: Codominant.
POSTOPERATIVE DIAGNOSIS:
Successful PCI to the mid RCA with a 3.0 x 24 mm Rebel bare metal
stent post dilated to 3.25 mm after successful Pronto aspiration
thrombectomy.
