mcauffman86
Networker
What would be the appropriate codes for this case? I came up with 93458-26,59, 92928-LC, 92928-RI, 36215-59, 36216-59, 75716-26,59. My provider did an upper and lower bilateral extremity angiogram, but the MUE allowed is only 1. Would I only code 1 unit even though upper and lower extremities were viewed?
Name of Procedure:
1. Left heart catheterization using a 6-French pigtail catheter.
2. Left ventricular cineangiogram using a 6-French pigtail catheter.
3. Selective coronary angiogram using an JL4 and an JR4 Judkins catheter.
4. Drug-eluting stent placement of 80% distal obtuse marginal branch using a 2.75 x 12 mm resolute onyX.
5. Drug-eluting stent placement of 95% ramus branch using a 2.0 x 8 mm resolute onyx.
6. Bilateral selective subclavian artery and axillary artery angiogram was performed using a JB2 catheter
7. Bilateral lower extremity angiogram with runoff was performed using a LIMA catheter
Moderate sedation performed using IV Versed and Fentanyl. Patient received continuous EKG, hemodynamic and oximetry monitoring. The attending physician was present and/or scrubbed for the entire procedures. Duration: 72 minutes.
Description of Procedure:
The patient was premedicated with Versed and fentanyl and was brought into the cath lab in a fasting state. Lidocaine 1% was used as a local anesthetic. After the right groin was anesthetized, vascular access was achieved without difficulty using the Lumify vascular ultrasound system as follows: Ultrasound guided vascular access was performed using the Lumify vascular system. The right common femoral artery was identified by Ultrasound above the profunda femoral branch. The vessel demonstrated good color flow and appears suitable for vascular access. Real time live visualization of vascular needle entry and direct puncture into the right common femoral artery was performed to ensure safe access to the vessel without double puncture. Vascular access was achieved with a single puncture without difficulty. A 7 french arterial sheath was introduced safely with Ultrasound guidance. There are no complications. The 6-French pigtail catheter was advanced into the left ventricle without difficulty. Left ventricular cineangiogram was performed without complications. Subsequently, selective coronary angiogram was performed using 6-French JL4 and 6-French JR4 Judkins catheters in multiple projections. Bilateral selective subclavian artery and axillary artery angiogram was performed using a JB2 catheter Bilateral lower extremity angiogram with runoff was performed using a LIMA catheter
Subsequently, coronary angiography demonstrated: The Left main artery: normal The left anterior descending artery has insignificant disease less than 40% stenosis The circumflex artery: 95% proximal ramus branch stenosis and 80% obtuse marginal branch stenosis The right coronary artery appears totally occluded with vascular coils with bridging collaterals LVgram: 50% ejection fraction with inferior basal hypokinesis
Bilateral upper extremity angiogram demonstrated insignificant right subclavian, right axillary and right brachial artery without stenosis. The left subclavian artery is free of any disease. Left axillary artery has a 50% discrete stenosis.
Bilateral lower extremity runoff demonstrated significant restenosis of the right SFA with in-stent restenosis to 80% with diffuse disease. The right SFA and popliteal artery is patent without significant stenosis
Intervention is therefore recommended due to class III angina and admission to the chest pain unit. Using a 6 voda 3 guiding catheter, we were able to engage the left main coronary artery. Through a flexible guidewire we were able to cross the 80% obtuse marginal branch stenosis. The vessel was ballooned using a 2.0 mm balloon with inadequate result and was stented using a 2.75 x 12 mm Resolute Onyx. The 95% ramus branch was ballooned using a 2.0 balloon with inadequate result and was stented using a 2.0 x 8 mm resolute On-X with excellent result. Residual 0% stenosis was seen post stent placement.
Cine Interpretation: LCX-OMB 80% was reduced to 0% post DES Ramus branch 95% was reduced to 0% post DES TIMI flow pre-intervention was 3. TIMI flow post-intervention was 3. Anti-platelet therapy will include: plavix *see Cath procedure log for details* Lesion Type: Type C Hemodynamics: Aortic pressure was: 9/12/2019 2/21/2020 2/21/2020 AO Systolic Pressure 75 130 131 AO Diastolic Pressure 52 68 73 AO Mean Pressure 60 89 82 LV pressure and LVEDP was: 2/21/2020 LV Systolic Pressure 136 LV Diastolic Pressure 5 LV End Diastolic Pressure 17 Some recent data might be hidden There is no gradient on LV/AO pullback.
Fluoroscopy: Demonstrated normal cardiac silhouette with visible coronary calcification.
The right groin sheath was removed using Angio-Seal closure device with good hemostasis and without complication. The patient tolerated the procedure well and was transferred to CVL recovery for post-procedure management.
Final Impression: Successful drug-eluting stent placement of the Lcx-OMB and the Ramus brabch was performed without complication.
Disposition: Patient is stable post procedure and will be transferred to CVL recovery for post procedure management.
Recommendation: Recommend aspirin and Plavix therapy for 12 months post DES placement. In view of severe left SFA restenosis, recommend staged peripheral artery angioplasty.
Name of Procedure:
1. Left heart catheterization using a 6-French pigtail catheter.
2. Left ventricular cineangiogram using a 6-French pigtail catheter.
3. Selective coronary angiogram using an JL4 and an JR4 Judkins catheter.
4. Drug-eluting stent placement of 80% distal obtuse marginal branch using a 2.75 x 12 mm resolute onyX.
5. Drug-eluting stent placement of 95% ramus branch using a 2.0 x 8 mm resolute onyx.
6. Bilateral selective subclavian artery and axillary artery angiogram was performed using a JB2 catheter
7. Bilateral lower extremity angiogram with runoff was performed using a LIMA catheter
Moderate sedation performed using IV Versed and Fentanyl. Patient received continuous EKG, hemodynamic and oximetry monitoring. The attending physician was present and/or scrubbed for the entire procedures. Duration: 72 minutes.
Description of Procedure:
The patient was premedicated with Versed and fentanyl and was brought into the cath lab in a fasting state. Lidocaine 1% was used as a local anesthetic. After the right groin was anesthetized, vascular access was achieved without difficulty using the Lumify vascular ultrasound system as follows: Ultrasound guided vascular access was performed using the Lumify vascular system. The right common femoral artery was identified by Ultrasound above the profunda femoral branch. The vessel demonstrated good color flow and appears suitable for vascular access. Real time live visualization of vascular needle entry and direct puncture into the right common femoral artery was performed to ensure safe access to the vessel without double puncture. Vascular access was achieved with a single puncture without difficulty. A 7 french arterial sheath was introduced safely with Ultrasound guidance. There are no complications. The 6-French pigtail catheter was advanced into the left ventricle without difficulty. Left ventricular cineangiogram was performed without complications. Subsequently, selective coronary angiogram was performed using 6-French JL4 and 6-French JR4 Judkins catheters in multiple projections. Bilateral selective subclavian artery and axillary artery angiogram was performed using a JB2 catheter Bilateral lower extremity angiogram with runoff was performed using a LIMA catheter
Subsequently, coronary angiography demonstrated: The Left main artery: normal The left anterior descending artery has insignificant disease less than 40% stenosis The circumflex artery: 95% proximal ramus branch stenosis and 80% obtuse marginal branch stenosis The right coronary artery appears totally occluded with vascular coils with bridging collaterals LVgram: 50% ejection fraction with inferior basal hypokinesis
Bilateral upper extremity angiogram demonstrated insignificant right subclavian, right axillary and right brachial artery without stenosis. The left subclavian artery is free of any disease. Left axillary artery has a 50% discrete stenosis.
Bilateral lower extremity runoff demonstrated significant restenosis of the right SFA with in-stent restenosis to 80% with diffuse disease. The right SFA and popliteal artery is patent without significant stenosis
Intervention is therefore recommended due to class III angina and admission to the chest pain unit. Using a 6 voda 3 guiding catheter, we were able to engage the left main coronary artery. Through a flexible guidewire we were able to cross the 80% obtuse marginal branch stenosis. The vessel was ballooned using a 2.0 mm balloon with inadequate result and was stented using a 2.75 x 12 mm Resolute Onyx. The 95% ramus branch was ballooned using a 2.0 balloon with inadequate result and was stented using a 2.0 x 8 mm resolute On-X with excellent result. Residual 0% stenosis was seen post stent placement.
Cine Interpretation: LCX-OMB 80% was reduced to 0% post DES Ramus branch 95% was reduced to 0% post DES TIMI flow pre-intervention was 3. TIMI flow post-intervention was 3. Anti-platelet therapy will include: plavix *see Cath procedure log for details* Lesion Type: Type C Hemodynamics: Aortic pressure was: 9/12/2019 2/21/2020 2/21/2020 AO Systolic Pressure 75 130 131 AO Diastolic Pressure 52 68 73 AO Mean Pressure 60 89 82 LV pressure and LVEDP was: 2/21/2020 LV Systolic Pressure 136 LV Diastolic Pressure 5 LV End Diastolic Pressure 17 Some recent data might be hidden There is no gradient on LV/AO pullback.
Fluoroscopy: Demonstrated normal cardiac silhouette with visible coronary calcification.
The right groin sheath was removed using Angio-Seal closure device with good hemostasis and without complication. The patient tolerated the procedure well and was transferred to CVL recovery for post-procedure management.
Final Impression: Successful drug-eluting stent placement of the Lcx-OMB and the Ramus brabch was performed without complication.
Disposition: Patient is stable post procedure and will be transferred to CVL recovery for post procedure management.
Recommendation: Recommend aspirin and Plavix therapy for 12 months post DES placement. In view of severe left SFA restenosis, recommend staged peripheral artery angioplasty.
