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ARE THE CHOICES OF THESE CODES CORRECT?
93459 26 59
92928 RC
92937 LD 59
36140 (59)
Left heart catheterization.
. Left ventriculogram.
. Coronary angiography.
. Saphenous vein angiography.
. Internal mammary angiography.
. Additional arterial access angioplasty and stenting of the
right coronary artery.
. Angioplasty and stenting of the left anterior descending
artery through the mammary graft.
INTERVENTION:
Based on findings at diagnostic catheterization we
proceeded with intervention on the right coronary artery. Angiomax
was administered and the right coronary was engaged with a MAC 3.0
guide catheter. I then advanced a Whisper wire into the posterior
descending artery and then tried to advance a 1.5 balloon;
however, after multiple attempts with several different balloons,
we were unable to cross the lesion. This was due to very poor
backup support from the #5 French guide. At this time, the
decision was made to change access site to the groin and I
obtained percutaneous access in the right common femoral artery. I
placed a #6 French sheath and then engaged the right coronary
artery with an XB-RCA #6 French guide catheter. I was able to
rewire the lesion with a run through wire. I was then able to
perform angioplasty with the 1.5 Sprinter balloon throughout the
right coronary artery and then a 2.0 x 20 Trek balloon. I then
tried to advance a 2.5 x 38 Promus Element stent into the right
coronary artery; however, I was unable to cross the proximal to
mid segment of the right coronary artery, again due to poor
backup. I then used a 6-French guide liner and the 2.0 balloon and
advanced the guide liner into the mid right coronary artery and
performed angioplasty through the mid right coronary artery. I was
unable to deliver the 2.5 x 38 mm Promus Element stent and covered
the lesions in the mid to distal right coronary artery. This stent
was deployed at high pressure for 40 seconds. I then returned with
a 2.5 x 12 balloon and angioplastied within the right coronary
stent proximally and in its mid segment up to a maximum of 18
atmospheres. After removal of balloons and wires there was TIMI-3
flow with no perforation, dissection or distal embolization.
Length of the lesions covered was 36 mm.
Attention was then turned to the LAD. I used a 5-French mammary
catheter to engage the left internal mammary artery. I advanced a
run-through wire across the lesion in the apical LAD. I used a 2.0
x 8 mm Trek balloon to dilate the distal LAD and then deployed a
2.25 x 8 mm Promus Element stent in the distal LAD at 9
atmospheres for over 30 seconds. After removal of balloons and
wires there was TIMI-3 flow with no perforation, dissection or
distal embolization. Angiography was performed of the common
femoral artery demonstrating arteriotomy above the bifurcation.
This was successfully sealed with a 6-French Perclose device.
Manual pressure was applied with a TR band to the left radial
access site.
THANKS FOR ANY ASSISTANCE!
93459 26 59
92928 RC
92937 LD 59
36140 (59)
Left heart catheterization.
. Left ventriculogram.
. Coronary angiography.
. Saphenous vein angiography.
. Internal mammary angiography.
. Additional arterial access angioplasty and stenting of the
right coronary artery.
. Angioplasty and stenting of the left anterior descending
artery through the mammary graft.
INTERVENTION:
Based on findings at diagnostic catheterization we
proceeded with intervention on the right coronary artery. Angiomax
was administered and the right coronary was engaged with a MAC 3.0
guide catheter. I then advanced a Whisper wire into the posterior
descending artery and then tried to advance a 1.5 balloon;
however, after multiple attempts with several different balloons,
we were unable to cross the lesion. This was due to very poor
backup support from the #5 French guide. At this time, the
decision was made to change access site to the groin and I
obtained percutaneous access in the right common femoral artery. I
placed a #6 French sheath and then engaged the right coronary
artery with an XB-RCA #6 French guide catheter. I was able to
rewire the lesion with a run through wire. I was then able to
perform angioplasty with the 1.5 Sprinter balloon throughout the
right coronary artery and then a 2.0 x 20 Trek balloon. I then
tried to advance a 2.5 x 38 Promus Element stent into the right
coronary artery; however, I was unable to cross the proximal to
mid segment of the right coronary artery, again due to poor
backup. I then used a 6-French guide liner and the 2.0 balloon and
advanced the guide liner into the mid right coronary artery and
performed angioplasty through the mid right coronary artery. I was
unable to deliver the 2.5 x 38 mm Promus Element stent and covered
the lesions in the mid to distal right coronary artery. This stent
was deployed at high pressure for 40 seconds. I then returned with
a 2.5 x 12 balloon and angioplastied within the right coronary
stent proximally and in its mid segment up to a maximum of 18
atmospheres. After removal of balloons and wires there was TIMI-3
flow with no perforation, dissection or distal embolization.
Length of the lesions covered was 36 mm.
Attention was then turned to the LAD. I used a 5-French mammary
catheter to engage the left internal mammary artery. I advanced a
run-through wire across the lesion in the apical LAD. I used a 2.0
x 8 mm Trek balloon to dilate the distal LAD and then deployed a
2.25 x 8 mm Promus Element stent in the distal LAD at 9
atmospheres for over 30 seconds. After removal of balloons and
wires there was TIMI-3 flow with no perforation, dissection or
distal embolization. Angiography was performed of the common
femoral artery demonstrating arteriotomy above the bifurcation.
This was successfully sealed with a 6-French Perclose device.
Manual pressure was applied with a TR band to the left radial
access site.
THANKS FOR ANY ASSISTANCE!