Jane5711
Networker
Hi, I'm not sure if I should charge for this attempted procedure with a 52. The Doctor did the work so I believe he should be reimbursed for his work.
1. Attempted angioplasty procedure.
2. Left heart catheterization with selective coronary artery angiography
of the right coronary artery.
3. Angio-Seal of the right femoral artery.
PROCEDURES: After the informed consent was obtained, the patient was
prepped and draped in the usual sterile fashion. Two percent lidocaine
was used for local anesthesia in the right groin and vascular access was
obtained in the right femoral artery. Over a guidewire, a 6-French short
arterial sheath was placed in the right femoral artery.
Over a guidewire, a 6-French IM guide was used, it could not work, and was
completely kinked, and another 6-French IM guide, which was without
sideholes was used, and again it was kinked, and hence it was decided that
there was severe kinking of the right iliac artery, for which the arterial
sheath and wire were removed along with the guide.
Then over a guidewire, a 6-French long arterial sheath was used again
using a KR4H guide. We tried to attempt engage the right coronary artery.
Again, the guiding catheter was kinked.
Hence, the 6-French long arterial sheath was removed over a guidewire
along with the guide, and a 6-French long arrow sheath, a flex-sheath, was
introduced through the right femoral artery.
Then, another KR4H guide was used to engage the right coronary artery, but
this was not successful.
Following this, AL1 guide was used, following which an AR1 guide was used,
following which a JR4 guide was used. All of them were unsuccessful
engaging the right coronary artery.
Finally, a 6-French ART 3.5 guide with sideholes was used, it was able to
engage the right coronary artery suboptimally, but right coronary artery
coronary angiographic images were obtained.
It was noted that the mid right coronary artery has a 60 percent calcific
stenosis which appears to be somewhat better than the previous images, and
hence it was decided to not intervene upon this lesion, particularly with
poor guide support, as well as with the severe widening of the aortic arch
and kinking of the right iliac artery.
It should be also noted that the right coronary artery seems to come up
posteriorly from the aortic root, which makes it even more difficult to
engage.
The guiding catheter and guidewires were removed. Arterial sheath removed
over the guidewire and a 6-French Angio-Seal was deployed in the right
femoral artery successfully without any complications. The patient
transferred in a stable condition to the floor for further care.
ASSESSMENT:
1. Prior to the procedure, there is a 60 percent stenosis of the mid
right coronary artery with heavy calcification, with the right
coronary artery coming up posteriorly.
2. The aortic arch is widened. There is significant kinking in the right
iliac artery, and the anatomy makes it extremely difficult for optimal
engagement of the right coronary artery except with ART 3.5 guide.
3. The stenosis in the right coronary artery remains as before without
any changes. No complications.
PLAN:
1. The patient will be continued on medical treatment.
2. If the patient has recurrent angina symptoms which requires
angioplasty of the right coronary artery, then recommend approaching
the right coronary artery through right brachial approach.
The codes I think should be:
93454, RC
POSSIBLE: 92920, RC 52
99152
Need help!!!! Thanks,
1. Attempted angioplasty procedure.
2. Left heart catheterization with selective coronary artery angiography
of the right coronary artery.
3. Angio-Seal of the right femoral artery.
PROCEDURES: After the informed consent was obtained, the patient was
prepped and draped in the usual sterile fashion. Two percent lidocaine
was used for local anesthesia in the right groin and vascular access was
obtained in the right femoral artery. Over a guidewire, a 6-French short
arterial sheath was placed in the right femoral artery.
Over a guidewire, a 6-French IM guide was used, it could not work, and was
completely kinked, and another 6-French IM guide, which was without
sideholes was used, and again it was kinked, and hence it was decided that
there was severe kinking of the right iliac artery, for which the arterial
sheath and wire were removed along with the guide.
Then over a guidewire, a 6-French long arterial sheath was used again
using a KR4H guide. We tried to attempt engage the right coronary artery.
Again, the guiding catheter was kinked.
Hence, the 6-French long arterial sheath was removed over a guidewire
along with the guide, and a 6-French long arrow sheath, a flex-sheath, was
introduced through the right femoral artery.
Then, another KR4H guide was used to engage the right coronary artery, but
this was not successful.
Following this, AL1 guide was used, following which an AR1 guide was used,
following which a JR4 guide was used. All of them were unsuccessful
engaging the right coronary artery.
Finally, a 6-French ART 3.5 guide with sideholes was used, it was able to
engage the right coronary artery suboptimally, but right coronary artery
coronary angiographic images were obtained.
It was noted that the mid right coronary artery has a 60 percent calcific
stenosis which appears to be somewhat better than the previous images, and
hence it was decided to not intervene upon this lesion, particularly with
poor guide support, as well as with the severe widening of the aortic arch
and kinking of the right iliac artery.
It should be also noted that the right coronary artery seems to come up
posteriorly from the aortic root, which makes it even more difficult to
engage.
The guiding catheter and guidewires were removed. Arterial sheath removed
over the guidewire and a 6-French Angio-Seal was deployed in the right
femoral artery successfully without any complications. The patient
transferred in a stable condition to the floor for further care.
ASSESSMENT:
1. Prior to the procedure, there is a 60 percent stenosis of the mid
right coronary artery with heavy calcification, with the right
coronary artery coming up posteriorly.
2. The aortic arch is widened. There is significant kinking in the right
iliac artery, and the anatomy makes it extremely difficult for optimal
engagement of the right coronary artery except with ART 3.5 guide.
3. The stenosis in the right coronary artery remains as before without
any changes. No complications.
PLAN:
1. The patient will be continued on medical treatment.
2. If the patient has recurrent angina symptoms which requires
angioplasty of the right coronary artery, then recommend approaching
the right coronary artery through right brachial approach.
The codes I think should be:
93454, RC
POSSIBLE: 92920, RC 52
99152
Need help!!!! Thanks,
