Wiki Cardiac code with distal runoff

[csorensen21@yahoo.com]

I'm not sure what to code for the distal runoff???

The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was prepped and draped in the usual manner. Using the modified Seldinger access technique, a 6 French sheath was placed in the left femoral artery. A left heart catheterization was done. Right and Left Coronary angiograms were also done. SVG agnography, LIMA angiography and LV gram were performed using 6F JR4 catheters. DSA to aoroiliac and ileofemoral, popliteal and infrapopliteal vessels was performed in a bolus chase fashion. A 6F LIMA catheter was then advanced through a stiff Glide wire to the mid infrapopliteal vessels.

Interventions: PCI to SVG to OM2.

PCI Procedure: Heparin Bolus, integrillin double bolus and drip were given along with IC NTG and cardiazem. 6F JR4 Guide was used, with 0.014 BMW wire, 4.0 mm Spider wire and primary stenting using 3.5x15mm Resolute DES deployed at 12-16 atm. Pre 90% mid SVG to OM2 stenosis, TIMI 3 flow. Final: No residual TIMI 3 flow After the procedure was completed, sedation was stopped and the sheaths and catheters were all removed. Hemostasis was achieved with angioseal.

Hemodynamics LVEDP=10
Left Main Patent with moderate diffuse disease
LAD Severe proximal and mid vessel disease, before Diag-1 and between Diag-1 and Diag-2
RCA Chronic total occlusion in mid portion
CIRC 90% proximal stenosis, 50-60 %stenosis mid vessel before OM1 competitive flow from OM2
OM1 competitive flow from OM2
SVG to OM2 90% proximal stenosis, supplies OM1 back flow, s/p stenting 0% residual
SVG to PDA, occluded
SVG to PL branch of RCA has 50% mid stenosis at a valve, patent PL branch w/blackflow to a severely diffusely diseased PDA.
SVG to Daig-1 widely patent
LIMA to LAD widely patent
LV LV angiogram was done and revealed proximal and mid severe IW hypokinesis Estimated ejection fraction is around 45%
Aortoiliac Angiography patent distal aorta with mild irregularities, 5% ostial R common iliac with 10mm Hg gradient.
Otherwise patent bilateral common, internal and external iliacs bilaterally.
Femoral angiography patent common femoral arteries and SFA bilaterally, except for 40% R SFA and 50% L SFA stenosis.
Popliteal and infrapopliteal angiography R popliteal with 90% stenosis, proximally and distally, 2 vessel runoff to the feet (PT and peroneal)
L popliteal with mild disease, 2 vessel runoff to the feet (PT and peroneal)
Vessel Dominance Right
Closure Device Angioseal
Complications NONE

Help please.

 

[Jim Pawloski]

I'm not sure what to code for the distal runoff???

The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient and/or family concurred with the proposed plan, giving informed consent. Patient was prepped and draped in the usual manner. Using the modified Seldinger access technique, a 6 French sheath was placed in the left femoral artery. A left heart catheterization was done. Right and Left Coronary angiograms were also done. SVG agnography, LIMA angiography and LV gram were performed using 6F JR4 catheters. DSA to aoroiliac and ileofemoral, popliteal and infrapopliteal vessels was performed in a bolus chase fashion. A 6F LIMA catheter was then advanced through a stiff Glide wire to the mid infrapopliteal vessels.

Interventions: PCI to SVG to OM2.

PCI Procedure: Heparin Bolus, integrillin double bolus and drip were given along with IC NTG and cardiazem. 6F JR4 Guide was used, with 0.014 BMW wire, 4.0 mm Spider wire and primary stenting using 3.5x15mm Resolute DES deployed at 12-16 atm. Pre 90% mid SVG to OM2 stenosis, TIMI 3 flow. Final: No residual TIMI 3 flow After the procedure was completed, sedation was stopped and the sheaths and catheters were all removed. Hemostasis was achieved with angioseal.

Hemodynamics LVEDP=10
Left Main Patent with moderate diffuse disease
LAD Severe proximal and mid vessel disease, before Diag-1 and between Diag-1 and Diag-2
RCA Chronic total occlusion in mid portion
CIRC 90% proximal stenosis, 50-60 %stenosis mid vessel before OM1 competitive flow from OM2
OM1 competitive flow from OM2
SVG to OM2 90% proximal stenosis, supplies OM1 back flow, s/p stenting 0% residual
SVG to PDA, occluded
SVG to PL branch of RCA has 50% mid stenosis at a valve, patent PL branch w/blackflow to a severely diffusely diseased PDA.
SVG to Daig-1 widely patent
LIMA to LAD widely patent
LV LV angiogram was done and revealed proximal and mid severe IW hypokinesis Estimated ejection fraction is around 45%
Aortoiliac Angiography patent distal aorta with mild irregularities, 5% ostial R common iliac with 10mm Hg gradient.
Otherwise patent bilateral common, internal and external iliacs bilaterally.
Femoral angiography patent common femoral arteries and SFA bilaterally, except for 40% R SFA and 50% L SFA stenosis.
Popliteal and infrapopliteal angiography R popliteal with 90% stenosis, proximally and distally, 2 vessel runoff to the feet (PT and peroneal)
L popliteal with mild disease, 2 vessel runoff to the feet (PT and peroneal)
Vessel Dominance Right
Closure Device Angioseal
Complications NONE

Help please.

I would code 93459, and 75716-59-xs.
HTH,
Jim Pawloski, CIRCC

 

[Chlrtrep]

I would code 93459, and 75716-59-xs.
HTH,
Jim Pawloski, CIRCC

Jim,

I am curious what is the reason for modifier -59 and -xs.

I am asking because -59 are to be replaced by the new -x modifiers. So in this case it seems like two -59 are being used.

Just curious I would be interested in your logic here.

Thanks
Charles

 

[cgbar]

4.0 mm Spider wire and primary stenting using 3.5x15mm Resolute DES deployed at 12-16 atm. Pre 90% mid SVG to OM2 stenosis,

I would code 92937-LC as well for the stent.

Also curious about the -XS and 59. What we have read seems to point us to using the -XU in place of the 59 for the Heart Cath when done with a PCI....although the info out there leaves a lot to be desired, IMO.

Glenn