amym
Guest
Is it appropriate to code this as 93458-26, 75710-26-59?
PROCEDURES PERFORMED:
-- Left heart catheterization with ventriculography.
-- Left coronary angiography.
-- Right coronary angiography.
-- Aorta Iliac Unilateral.
-- Right leg angiography.
RECOMMENDATIONS:
Only RLE imaging was performed in the cath lab.
Severe disease involving the RLE was visualized only to the level of TP
trunk.
A full LE run-off and Atherectomy of the LE shall be scheduled in two
weeks.
No dye reaction occurred (pt was premedicated).
INDICATIONS: Angina/MI: atypical chest pain.
PRIOR DIAGNOSTIC TEST RESULTS: Nuclear pharmacologic stress test was
positive.
VENTRICLES: There were no left ventricular global or regional wall motion
abnormalities. EF calculated by contrast ventriculography was 60 %.
VALVES: AORTIC VALVE: The aortic valve was evaluated by left
ventriculography. The aortic valve appeared to be structurally normal. The
aortic valve leaflets exhibited normal thickness and normal excursion.
There was no aortic stenosis. MITRAL VALVE: The mitral valve was evaluated
by left ventriculography. The mitral valve appeared grossly normal. The
mitral leaflets exhibited normal thickness and normal excursion. The
mitral valve exhibited no regurgitation.
CORONARY VESSELS: The coronary circulation is right dominant. Coronary
angiography demonstrated minor luminal irregularities. Left main:
Angiography showed minor luminal irregularities. LAD: Angiography showed
minor luminal irregularities. Mid LAD: There was a 30 % stenosis.
Circumflex: Angiography showed minor luminal irregularities. RCA:
Angiography showed minor luminal irregularities.
RIGHT LOWER EXTREMITY VESSELS: Right lower extremity angiography reveals
severe atherosclerosis. Proximal right deep femoral: There was a 70 %
stenosis. Mid right deep femoral: There was a 80 % stenosis. Distal right
deep femoral: There was a 80 % stenosis. Proximal right anterior tibial:
There was a 100 % stenosis. Right posterior tibial: There was a 100 %
stenosis.
PROCEDURE: The risks and alternatives of the procedures and conscious
sedation were explained to the patient and informed consent was obtained.
The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile
fashion.
-- Right femoral artery access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Left heart catheterization. A catheter was advanced to the ascending
aorta. After recording ascending aortic pressure, the catheter was
advanced across the aortic valve and left ventricular pressure was
recorded. Ventriculography was performed using power injection of contrast
agent. Imaging was performed using an RAO projection.
-- Left coronary artery angiography. A catheter was advanced to the aorta
and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Right coronary artery angiography. A catheter was advanced to the
aorta and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Aorta Iliac Unilateral.
-- Right leg angiography. A catheter was positioned.
COMPLICATIONS:
There were no adverse outcomes.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
Test started at 09:47. Test concluded at 10:05. RADIATION EXPOSURE:
Fluoroscopy time: 2 min.
HEMOSTASIS:
The sheath was removed. The site was compressed manually. Hemostasis was
successful.
MEDICATIONS GIVEN:
Midazolam, 1 mg, IV, at 09:44.
CONTRAST GIVEN:
Omnipaque 35 ml.
PROCEDURES PERFORMED:
-- Left heart catheterization with ventriculography.
-- Left coronary angiography.
-- Right coronary angiography.
-- Aorta Iliac Unilateral.
-- Right leg angiography.
RECOMMENDATIONS:
Only RLE imaging was performed in the cath lab.
Severe disease involving the RLE was visualized only to the level of TP
trunk.
A full LE run-off and Atherectomy of the LE shall be scheduled in two
weeks.
No dye reaction occurred (pt was premedicated).
INDICATIONS: Angina/MI: atypical chest pain.
PRIOR DIAGNOSTIC TEST RESULTS: Nuclear pharmacologic stress test was
positive.
VENTRICLES: There were no left ventricular global or regional wall motion
abnormalities. EF calculated by contrast ventriculography was 60 %.
VALVES: AORTIC VALVE: The aortic valve was evaluated by left
ventriculography. The aortic valve appeared to be structurally normal. The
aortic valve leaflets exhibited normal thickness and normal excursion.
There was no aortic stenosis. MITRAL VALVE: The mitral valve was evaluated
by left ventriculography. The mitral valve appeared grossly normal. The
mitral leaflets exhibited normal thickness and normal excursion. The
mitral valve exhibited no regurgitation.
CORONARY VESSELS: The coronary circulation is right dominant. Coronary
angiography demonstrated minor luminal irregularities. Left main:
Angiography showed minor luminal irregularities. LAD: Angiography showed
minor luminal irregularities. Mid LAD: There was a 30 % stenosis.
Circumflex: Angiography showed minor luminal irregularities. RCA:
Angiography showed minor luminal irregularities.
RIGHT LOWER EXTREMITY VESSELS: Right lower extremity angiography reveals
severe atherosclerosis. Proximal right deep femoral: There was a 70 %
stenosis. Mid right deep femoral: There was a 80 % stenosis. Distal right
deep femoral: There was a 80 % stenosis. Proximal right anterior tibial:
There was a 100 % stenosis. Right posterior tibial: There was a 100 %
stenosis.
PROCEDURE: The risks and alternatives of the procedures and conscious
sedation were explained to the patient and informed consent was obtained.
The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile
fashion.
-- Right femoral artery access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Left heart catheterization. A catheter was advanced to the ascending
aorta. After recording ascending aortic pressure, the catheter was
advanced across the aortic valve and left ventricular pressure was
recorded. Ventriculography was performed using power injection of contrast
agent. Imaging was performed using an RAO projection.
-- Left coronary artery angiography. A catheter was advanced to the aorta
and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Right coronary artery angiography. A catheter was advanced to the
aorta and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Aorta Iliac Unilateral.
-- Right leg angiography. A catheter was positioned.
COMPLICATIONS:
There were no adverse outcomes.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
Test started at 09:47. Test concluded at 10:05. RADIATION EXPOSURE:
Fluoroscopy time: 2 min.
HEMOSTASIS:
The sheath was removed. The site was compressed manually. Hemostasis was
successful.
MEDICATIONS GIVEN:
Midazolam, 1 mg, IV, at 09:44.
CONTRAST GIVEN:
Omnipaque 35 ml.
