amym
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Physician turned in charges for LHC + Grafts and Bypass Angio. I have attached a report and am not sure how to code the Bypass Angio. Please help!
SUMMARY:
-- CARDIAC STRUCTURES:
-- Global left ventricular function was normal. EF estimated was 60 %.
-- HEMODYNAMICS:
-- Hemodynamic assessment demonstrates moderate systemic hypertension.
PROCEDURES PERFORMED:
-- Left heart catheterization with ventriculography.
-- Left coronary angiography.
-- Right coronary angiography.
-- Saphenous vein graft angiography.
-- LIMA graft angiography.
RECOMMENDATIONS:
EF60%, no MR, R dominant. LM has LI. LCX has LI. Small ramus has ostial
70%. LAD has LI. RCA has distal 50% stenosis before the crux. VG to distal
RCA is widely patent. LIMA to LAD is atretic and subtotalled. Medical
therapy and risk factor modification.
INDICATIONS: chest pain and abnormal stress test
HEMODYNAMICS: Hemodynamic assessment demonstrates moderate systemic
hypertension.
VENTRICLES: There were no left ventricular global or regional wall motion
abnormalities. Global left ventricular function was normal. EF estimated
was 60 %.
VALVES: MITRAL VALVE: The mitral valve exhibited no regurgitation.
CORONARY VESSELS: The coronary circulation is right dominant. non
obstructive coronary artery disease, atretic LIMA. Left main: Angiography
showed minor luminal irregularities. LAD: Angiography showed mild
atherosclerosis. Circumflex: Angiography showed mild atherosclerosis.
Ramus intermedius: The vessel was very small sized. There was a 70 %
stenosis at the ostium of the vessel segment. RCA: Angiography showed mild
atherosclerosis. There was a 50 % stenosis in the distal third of the
vessel segment. Graft to the LAD: The graft was a LIMA. There was a 99 %
stenosis at the distal anastomosis.
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.
-- Left internal mammary 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.
COMPLICATIONS:
None occurred during the cath lab visit.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
Test started at 09:30. Test concluded at 10:17. RADIATION EXPOSURE:
Fluoroscopy time: 20.7 min.
MEDICATIONS GIVEN:
Midazolam, 1 mg, IV, at 09:30.
CONTRAST GIVEN:
Omnipaque 160 ml.
STUDY DIAGRAM
Angiographic findings
Native coronary lesions:
7Ramus intermedius: Lesion 1: 70 % stenosis.
7RCA: Lesion 1: 50 % stenosis.
Coronary graft lesions:
7Graft to LAD: LIMA 7 99 % stenosis at distal anastomosis.
HEMODYNAMIC TABLES
Pressures: NO PHASE
Pressures: - HR: 53
Pressures: - Rhythm:
Pressures: -- Aortic Pressure (S/D/M): 202/61/112
Outputs: NO PHASE
Outputs: -- CALCULATIONS: Age in years: 85.37
Outputs: -- CALCULATIONS: Body Surface Area: 1.60
Outputs: -- CALCULATIONS: Height in cm: 157.00
Outputs: -- CALCULATIONS: Sex: Female
Outputs: -- CALCULATIONS: Weight in kg: 60.10
SUMMARY:
-- CARDIAC STRUCTURES:
-- Global left ventricular function was normal. EF estimated was 60 %.
-- HEMODYNAMICS:
-- Hemodynamic assessment demonstrates moderate systemic hypertension.
PROCEDURES PERFORMED:
-- Left heart catheterization with ventriculography.
-- Left coronary angiography.
-- Right coronary angiography.
-- Saphenous vein graft angiography.
-- LIMA graft angiography.
RECOMMENDATIONS:
EF60%, no MR, R dominant. LM has LI. LCX has LI. Small ramus has ostial
70%. LAD has LI. RCA has distal 50% stenosis before the crux. VG to distal
RCA is widely patent. LIMA to LAD is atretic and subtotalled. Medical
therapy and risk factor modification.
INDICATIONS: chest pain and abnormal stress test
HEMODYNAMICS: Hemodynamic assessment demonstrates moderate systemic
hypertension.
VENTRICLES: There were no left ventricular global or regional wall motion
abnormalities. Global left ventricular function was normal. EF estimated
was 60 %.
VALVES: MITRAL VALVE: The mitral valve exhibited no regurgitation.
CORONARY VESSELS: The coronary circulation is right dominant. non
obstructive coronary artery disease, atretic LIMA. Left main: Angiography
showed minor luminal irregularities. LAD: Angiography showed mild
atherosclerosis. Circumflex: Angiography showed mild atherosclerosis.
Ramus intermedius: The vessel was very small sized. There was a 70 %
stenosis at the ostium of the vessel segment. RCA: Angiography showed mild
atherosclerosis. There was a 50 % stenosis in the distal third of the
vessel segment. Graft to the LAD: The graft was a LIMA. There was a 99 %
stenosis at the distal anastomosis.
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.
-- Left internal mammary 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.
COMPLICATIONS:
None occurred during the cath lab visit.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
Test started at 09:30. Test concluded at 10:17. RADIATION EXPOSURE:
Fluoroscopy time: 20.7 min.
MEDICATIONS GIVEN:
Midazolam, 1 mg, IV, at 09:30.
CONTRAST GIVEN:
Omnipaque 160 ml.
STUDY DIAGRAM
Angiographic findings
Native coronary lesions:
7Ramus intermedius: Lesion 1: 70 % stenosis.
7RCA: Lesion 1: 50 % stenosis.
Coronary graft lesions:
7Graft to LAD: LIMA 7 99 % stenosis at distal anastomosis.
HEMODYNAMIC TABLES
Pressures: NO PHASE
Pressures: - HR: 53
Pressures: - Rhythm:
Pressures: -- Aortic Pressure (S/D/M): 202/61/112
Outputs: NO PHASE
Outputs: -- CALCULATIONS: Age in years: 85.37
Outputs: -- CALCULATIONS: Body Surface Area: 1.60
Outputs: -- CALCULATIONS: Height in cm: 157.00
Outputs: -- CALCULATIONS: Sex: Female
Outputs: -- CALCULATIONS: Weight in kg: 60.10