amym
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Can I bill for the angiogram in addition to 93459 and what code would I use?
PROCEDURES PERFORMED: -- Left heart catheterization with ventriculography. -- LIMA graft angiography. -- Saphenous vein graft angiography. -- Saphenous vein graft angiography. -- Saphenous vein graft angiography. -- Saphenous vein graft angiography.
RECOMMENDATIONS: Aortogram showed an extreme tortuosity of both R and L iliac arteries. LV gram and LHC not attempted. Non-selective native L coronary angiography showed proximal LAD disease but it's difficult to quantify the amount of stenosis. Native RCA angiography showed 90% prox and 100% mid occlusion. Non-selective LIMA to LAD showed widely patent graft. VG to Om1 showed proximal 50% stenosis. VG to OM2 was widely patent. VG to RPDA was widely patent. Pt is to conitinue med therapy and risk factor modification.
INDICATIONS: CAD, positive stress test. HEMODYNAMICS: Hemodynamic assessment demonstrates moderate systemic hypertension. CORONARY VESSELS: The coronary circulation is right dominant. severe native CAD and patent CABG Left main: Normal. LAD: Angiography showed moderate atherosclerosis. Circumflex: Angiography showed moderate atherosclerosis. RCA: There was a 90 % stenosis in the proximal third of the vessel segment. In a second lesion, there was a 100 % stenosis in the middle third of the vessel segment. Graft to the LAD: The graft was a LIMA. Graft angiography showed no evidence of disease. Graft to the 1st obtuse marginal: The graft was a saphenous vein graft. There was a 50 % stenosis in the proximal third of the graft. Graft to the 2nd obtuse marginal: The graft was a saphenous vein graft. Graft angiography showed no evidence of disease.
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 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. –
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. –
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. –
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. –
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.
COMPLICATIONS: There were no adverse outcomes. None occurred during the cath lab visit.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING: Test started at 11:04. Test concluded at 12:29.
RADIATION EXPOSURE: Fluoroscopy time: 33.3 min.
STUDY DIAGRAM Angiographic findings Native coronary lesions: 7RCA: Lesion 1: 90 % stenosis. Lesion 2: 100 % stenosis. Coronary graft lesions: 7Graft to OM1: SVG [Graft not pictured] 7 Proximal 1/3 lesion 1: 50 % stenosis in proximal graft. HEMODYNAMIC TABLES Pressures: Baseline Pressures: - HR: 78 Pressures: - Rhythm: Pressures: -- Aortic Pressure (S/D/M): 167/78/115 Outputs: Baseline Outputs: -- CALCULATIONS: Age in years: 79.76 Outputs: -- CALCULATIONS: Body Surface Area: 2.12 Outputs: -- CALCULATIONS: Height in cm: 175.00 Outputs: -- CALCULATIONS: Sex: Male Outputs: -- CALCULATIONS: Weight in kg: 97.10 DICTATED BY: 23481
PROCEDURES PERFORMED: -- Left heart catheterization with ventriculography. -- LIMA graft angiography. -- Saphenous vein graft angiography. -- Saphenous vein graft angiography. -- Saphenous vein graft angiography. -- Saphenous vein graft angiography.
RECOMMENDATIONS: Aortogram showed an extreme tortuosity of both R and L iliac arteries. LV gram and LHC not attempted. Non-selective native L coronary angiography showed proximal LAD disease but it's difficult to quantify the amount of stenosis. Native RCA angiography showed 90% prox and 100% mid occlusion. Non-selective LIMA to LAD showed widely patent graft. VG to Om1 showed proximal 50% stenosis. VG to OM2 was widely patent. VG to RPDA was widely patent. Pt is to conitinue med therapy and risk factor modification.
INDICATIONS: CAD, positive stress test. HEMODYNAMICS: Hemodynamic assessment demonstrates moderate systemic hypertension. CORONARY VESSELS: The coronary circulation is right dominant. severe native CAD and patent CABG Left main: Normal. LAD: Angiography showed moderate atherosclerosis. Circumflex: Angiography showed moderate atherosclerosis. RCA: There was a 90 % stenosis in the proximal third of the vessel segment. In a second lesion, there was a 100 % stenosis in the middle third of the vessel segment. Graft to the LAD: The graft was a LIMA. Graft angiography showed no evidence of disease. Graft to the 1st obtuse marginal: The graft was a saphenous vein graft. There was a 50 % stenosis in the proximal third of the graft. Graft to the 2nd obtuse marginal: The graft was a saphenous vein graft. Graft angiography showed no evidence of disease.
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 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. –
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. –
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. –
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. –
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.
COMPLICATIONS: There were no adverse outcomes. None occurred during the cath lab visit.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING: Test started at 11:04. Test concluded at 12:29.
RADIATION EXPOSURE: Fluoroscopy time: 33.3 min.
STUDY DIAGRAM Angiographic findings Native coronary lesions: 7RCA: Lesion 1: 90 % stenosis. Lesion 2: 100 % stenosis. Coronary graft lesions: 7Graft to OM1: SVG [Graft not pictured] 7 Proximal 1/3 lesion 1: 50 % stenosis in proximal graft. HEMODYNAMIC TABLES Pressures: Baseline Pressures: - HR: 78 Pressures: - Rhythm: Pressures: -- Aortic Pressure (S/D/M): 167/78/115 Outputs: Baseline Outputs: -- CALCULATIONS: Age in years: 79.76 Outputs: -- CALCULATIONS: Body Surface Area: 2.12 Outputs: -- CALCULATIONS: Height in cm: 175.00 Outputs: -- CALCULATIONS: Sex: Male Outputs: -- CALCULATIONS: Weight in kg: 97.10 DICTATED BY: 23481