Hi all,
I'm pretty sure this isn't separately billable at all but wanted to be sure before I put the charges for the cath through. (Billing physician side so just professional portion...) Appears to be a pharmacologic cardioversion I thought.
INDICATION FOR STUDY: Atrial arrhythmia, congestive heart failure, myocardial infarction, and coronary artery disease.
STUDIES PERFORMED: Adenosine infusion study for the dysrhythmia, left heart cath, coronary angiogram, left ventriculogram,
PROCEDURE DATA: Right groin anesthetized with 2% Lidocaine. Subsequently, a 6-French sheath inserted in the right femoral artery. A 6-French JL4, JR4 were used for diagnostic cath. At the end of procedure, Angio-Seal was deployed.
HEMODYNAMIC DATA: The left ventricular pressure is 108 with end-diastolic pressure of 28. Pullback aortic pressure 108/61. There is no significant transaortic valve gradient.
ADENOSINE STUDY: The patient initially given 6 mg intravenous Adenosine; however, this failed to convert any rhythm. After that, 12 mg of intravenous Adenosine was delivered to left forearm venous puncture site. Subsequently, demonstrated that the patient actually being in atrial tachycardia. The patient did have sinus rhythm restored at a heart rate of 50s; however, the atrial rhythm quickly taken over and keeps the heart paced rates at the 90s.
ANGIOGRAPHIC DATA: The left main has no obstruction. Left anterior descending artery prior stent is patent. The rest of the vessel has atherosclerotic changes without hemodynamic significant disease. The left circumflex at proximal portion has 50% stenosis. The OM stent is patent. Right coronary artery stent is widely patent. Left ventriculogram showed dilated left ventricle with severe diffuse left hypokinesis with EF of about 15%.
CONCLUSIONS:
1. Nonobstructive coronary artery disease and patent prior stents at LAD, diagonal OM and RCA.
2. Atrial tachycardia was noted.
3. Markedly elevated left ventricular end-diastolic pressure. No significant transaortic valve gradient.
4. Severe left ventricular dysfunction with diffuse left ventricular hypokinesis, EF about 15% to 20%.
Jessica CPC, CCC
I'm pretty sure this isn't separately billable at all but wanted to be sure before I put the charges for the cath through. (Billing physician side so just professional portion...) Appears to be a pharmacologic cardioversion I thought.
INDICATION FOR STUDY: Atrial arrhythmia, congestive heart failure, myocardial infarction, and coronary artery disease.
STUDIES PERFORMED: Adenosine infusion study for the dysrhythmia, left heart cath, coronary angiogram, left ventriculogram,
PROCEDURE DATA: Right groin anesthetized with 2% Lidocaine. Subsequently, a 6-French sheath inserted in the right femoral artery. A 6-French JL4, JR4 were used for diagnostic cath. At the end of procedure, Angio-Seal was deployed.
HEMODYNAMIC DATA: The left ventricular pressure is 108 with end-diastolic pressure of 28. Pullback aortic pressure 108/61. There is no significant transaortic valve gradient.
ADENOSINE STUDY: The patient initially given 6 mg intravenous Adenosine; however, this failed to convert any rhythm. After that, 12 mg of intravenous Adenosine was delivered to left forearm venous puncture site. Subsequently, demonstrated that the patient actually being in atrial tachycardia. The patient did have sinus rhythm restored at a heart rate of 50s; however, the atrial rhythm quickly taken over and keeps the heart paced rates at the 90s.
ANGIOGRAPHIC DATA: The left main has no obstruction. Left anterior descending artery prior stent is patent. The rest of the vessel has atherosclerotic changes without hemodynamic significant disease. The left circumflex at proximal portion has 50% stenosis. The OM stent is patent. Right coronary artery stent is widely patent. Left ventriculogram showed dilated left ventricle with severe diffuse left hypokinesis with EF of about 15%.
CONCLUSIONS:
1. Nonobstructive coronary artery disease and patent prior stents at LAD, diagonal OM and RCA.
2. Atrial tachycardia was noted.
3. Markedly elevated left ventricular end-diastolic pressure. No significant transaortic valve gradient.
4. Severe left ventricular dysfunction with diffuse left ventricular hypokinesis, EF about 15% to 20%.
Jessica CPC, CCC