amym
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We have billed this as 93459-26-59, 92920-RC, 92920-LM, is that appropriate? -Thanks in advance.
SUMMARY:
-- CORONARY CIRCULATION:
-- Distal left main: There was a diffuse 30 % stenosis at the site of a
prior stent, in the middle third of the vessel. There was TIMI grade 3
flow through the vessel (brisk flow). This is a likely culprit for the
patient's clinical presentation. An intervention was performed. -- Right
PDA: There was a discrete 100 % stenosis at the site of a prior stent, in
the middle third of the vessel segment. There was TIMI grade 0 flow
through the vessel (no flow). This lesion is a likely culprit for the
patient's anginal symptoms. An intervention was performed.
-- CARDIAC STRUCTURES:
-- EF was not assessed.
-- 1ST LESION INTERVENTIONS:
-- A balloon angioplasty was performed on the 100 % lesion in the distal
RCA. Following intervention there was a 0 % residual stenosis.
-- 2ND LESION INTERVENTIONS:
-- A balloon angioplasty was performed on the 40 % lesion in the left
main. Following intervention there was a 0 % residual stenosis.
PROCEDURES PERFORMED:
-- Left heart catheterization with ventriculography.
-- Left coronary angiography.
-- Right coronary angiography.
-- Saphenous vein graft angiography.
-- Coronary Angioplasty.
-- Interventional IVUS.
-- Intervention on distal RCA: balloon angioplasty.
-- Intervention on left main: balloon angioplasty.
INDICATIONS: Angina/MI: unstable angina.
HEMODYNAMICS: Hemodynamic assessment demonstrates normal hemodynamics.
VENTRICLES: EF was not assessed.
CORONARY VESSELS: The coronary circulation is right dominant. Left main:
There was a 40 % stenosis. Distal left main: There was a diffuse 30 %
stenosis at the site of a prior stent, in the middle third of the vessel.
There was TIMI grade 3 flow through the vessel (brisk flow). This is a
likely culprit for the patient's clinical presentation. An intervention
was performed. Proximal LAD: The vessel was normal sized. Angiography
showed no evidence of disease. Mid LAD: Angiography showed minor luminal
irregularities. Distal LAD: Angiography showed minor luminal
irregularities. Proximal circumflex: There was a 100 % stenosis. Proximal
RCA: Normal. Mid RCA: Normal. Distal RCA: Normal. There was a 100 %
stenosis. Right PDA: There was a discrete 100 % stenosis at the site of a
prior stent, in the middle third of the vessel segment. There was TIMI
grade 0 flow through the vessel (no flow). This lesion is a likely culprit
for the patient's anginal symptoms. An intervention was performed.
PROCEDURE: The risks and alternatives of the procedures and conscious
sedation were explained to the patient and informed consent was obtained.
The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile
fashion.
-- Right femoral artery access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Left heart catheterization. A catheter was advanced to the ascending
aorta. After recording ascending aortic pressure, the catheter was
advanced across the aortic valve and left ventricular pressure was
recorded. Ventriculography was performed using power injection of contrast
agent. Imaging was performed using an RAO projection.
-- Left coronary artery angiography. A catheter was advanced to the aorta
and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Right coronary artery angiography. A catheter was advanced to the
aorta and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Saphenous vein graft angiography. A catheter was advanced to the aorta
and positioned at the aortic anastomosis of the graft under fluoroscopic
guidance. Angiography was performed in multiple projections using
hand-injection of contrast.
LESION #1 INTERVENTION: A balloon angioplasty was performed on the 100 %
lesion in the distal RCA. Following intervention there was a 0 % residual
stenosis.
-- Vessel setup was performed. A BMW HT 190cm wire was used to cross the
lesion.
-- Vessel setup was performed. A Runway 6FR FR4 SH guiding catheter was
used to cannulate the vessel.
-- Balloon angioplasty was performed, using a Sprinter 1.5 x 12 balloon,
with 1 inflations and a maximum inflation pressure of 15 atm.
-- Balloon angioplasty was performed, using a NC Sprinter 2.5 x 6
balloon, with 2 inflations and a maximum inflation pressure of 22 atm.
LESION #2 INTERVENTION: A balloon angioplasty was performed on the 40 %
lesion in the left main. Following intervention there was a 0 % residual
stenosis. There was no dissection.
-- Balloon angioplasty was performed, using a NC Sprinter 5.0 x 15
balloon, with 3 inflations and a maximum inflation pressure of 20 atm.
CARDIAC INTERVENTIONS
-- Coronary Angioplasty.
-- Interventional IVUS.
SUMMARY:
-- CORONARY CIRCULATION:
-- Distal left main: There was a diffuse 30 % stenosis at the site of a
prior stent, in the middle third of the vessel. There was TIMI grade 3
flow through the vessel (brisk flow). This is a likely culprit for the
patient's clinical presentation. An intervention was performed. -- Right
PDA: There was a discrete 100 % stenosis at the site of a prior stent, in
the middle third of the vessel segment. There was TIMI grade 0 flow
through the vessel (no flow). This lesion is a likely culprit for the
patient's anginal symptoms. An intervention was performed.
-- CARDIAC STRUCTURES:
-- EF was not assessed.
-- 1ST LESION INTERVENTIONS:
-- A balloon angioplasty was performed on the 100 % lesion in the distal
RCA. Following intervention there was a 0 % residual stenosis.
-- 2ND LESION INTERVENTIONS:
-- A balloon angioplasty was performed on the 40 % lesion in the left
main. Following intervention there was a 0 % residual stenosis.
PROCEDURES PERFORMED:
-- Left heart catheterization with ventriculography.
-- Left coronary angiography.
-- Right coronary angiography.
-- Saphenous vein graft angiography.
-- Coronary Angioplasty.
-- Interventional IVUS.
-- Intervention on distal RCA: balloon angioplasty.
-- Intervention on left main: balloon angioplasty.
INDICATIONS: Angina/MI: unstable angina.
HEMODYNAMICS: Hemodynamic assessment demonstrates normal hemodynamics.
VENTRICLES: EF was not assessed.
CORONARY VESSELS: The coronary circulation is right dominant. Left main:
There was a 40 % stenosis. Distal left main: There was a diffuse 30 %
stenosis at the site of a prior stent, in the middle third of the vessel.
There was TIMI grade 3 flow through the vessel (brisk flow). This is a
likely culprit for the patient's clinical presentation. An intervention
was performed. Proximal LAD: The vessel was normal sized. Angiography
showed no evidence of disease. Mid LAD: Angiography showed minor luminal
irregularities. Distal LAD: Angiography showed minor luminal
irregularities. Proximal circumflex: There was a 100 % stenosis. Proximal
RCA: Normal. Mid RCA: Normal. Distal RCA: Normal. There was a 100 %
stenosis. Right PDA: There was a discrete 100 % stenosis at the site of a
prior stent, in the middle third of the vessel segment. There was TIMI
grade 0 flow through the vessel (no flow). This lesion is a likely culprit
for the patient's anginal symptoms. An intervention was performed.
PROCEDURE: The risks and alternatives of the procedures and conscious
sedation were explained to the patient and informed consent was obtained.
The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile
fashion.
-- Right femoral artery access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Left heart catheterization. A catheter was advanced to the ascending
aorta. After recording ascending aortic pressure, the catheter was
advanced across the aortic valve and left ventricular pressure was
recorded. Ventriculography was performed using power injection of contrast
agent. Imaging was performed using an RAO projection.
-- Left coronary artery angiography. A catheter was advanced to the aorta
and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Right coronary artery angiography. A catheter was advanced to the
aorta and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Saphenous vein graft angiography. A catheter was advanced to the aorta
and positioned at the aortic anastomosis of the graft under fluoroscopic
guidance. Angiography was performed in multiple projections using
hand-injection of contrast.
LESION #1 INTERVENTION: A balloon angioplasty was performed on the 100 %
lesion in the distal RCA. Following intervention there was a 0 % residual
stenosis.
-- Vessel setup was performed. A BMW HT 190cm wire was used to cross the
lesion.
-- Vessel setup was performed. A Runway 6FR FR4 SH guiding catheter was
used to cannulate the vessel.
-- Balloon angioplasty was performed, using a Sprinter 1.5 x 12 balloon,
with 1 inflations and a maximum inflation pressure of 15 atm.
-- Balloon angioplasty was performed, using a NC Sprinter 2.5 x 6
balloon, with 2 inflations and a maximum inflation pressure of 22 atm.
LESION #2 INTERVENTION: A balloon angioplasty was performed on the 40 %
lesion in the left main. Following intervention there was a 0 % residual
stenosis. There was no dissection.
-- Balloon angioplasty was performed, using a NC Sprinter 5.0 x 15
balloon, with 3 inflations and a maximum inflation pressure of 20 atm.
CARDIAC INTERVENTIONS
-- Coronary Angioplasty.
-- Interventional IVUS.
