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are these correct codes?
93461 26 59
92980
75710 26 59
92973?
After obtaining informed consent, the patient was transported in
the nonsedated condition to the cardiac catheterization suite. The
patient was prepped and draped in a sterile fashion. Lidocaine 2%
was used to infiltrate the skin and subcutaneous tissue overlying
the left common femoral artery. A #6 French introducer sheath was
placed in the left common femoral artery utilizing the Seldinger
technique. After obtaining access in the left common femoral
artery and placing a short #6 French sheath, we were unable to
pass a standard J-wire up the iliac artery due to tortuosity. We
performed angiography and found an ectatic region with a tight
hairpin bend that was impeding our flow. We therefore changed our
J-wire for a Wholey wire with which we were able to negotiate the
extreme tortuosity in the left common iliac artery. Once the
Wholey wire was advanced, we removed our #6 French short sheath
and exchanged it for a #6 French Arrow Superflex sheath with which
we advanced this under fluoroscopic guidance into the descending
aorta. I then used a #6 French multipurpose catheter to cross the
aortic valve and performed a hand injection of the left ventricle.
We measured end-diastolic pressure and pullback across the aortic
valve. The multipurpose catheter was then used for native right
coronary artery, saphenous vein angiography, and was exchanged for
a JL-5 catheter which was used to engage the left main coronary
artery for angiography. We used a mammary catheter to engage the
left internal mammary artery. Due to difficulty extending a
standard glide wire and Wholey wire up the right subclavian
artery, we returned with a #5 French VTK catheter with which we
engaged the origin of the right subclavian artery. I then
advanced a glide wire into the distal subclavian and over this
advanced my VTK catheter. I then exchanged out the glide wire for
a long Wholey wire and placed an LCB catheter into the right
subclavian artery. With this, we were able to perform right
internal mammary angiography.
After accessing the common femoral artery, attention was turned to
the common femoral vein. Utilizing the Seldinger technique, a #7
French introducer sheath was placed in the common femoral vein.
The #7 French balloon-tipped PA catheter was introduced into the
sheath, the balloon was inflated and the catheter was manipulated
into the pulmonary artery. The wedge position was confirmed by
pressure tracing and the balloon was deflated. Thermodilution
cardiac outputs were then performed. After completion of the
outputs, the pigtail catheter was advanced across the aortic valve
and simultaneous pressures were obtained. The balloon on the Swan
catheter was inflated and simultaneous LV wedge pressure was
obtained followed by sequential pressures during a PA catheter
pullback. These pressures include simultaneous LV/PA, LV/RV, and
LV/right atrial pressures. The balloon catheter was subsequently
removed and we proceeded with LV-gram and coronary angiography.
We then proceeded with the intervention as described below.
Following completion of our intervention, we performed a standard
right heart catheterization utilizing a Swan Ganz balloon
floatation catheter which we advanced under fluoroscopic guidance
into the wedge position, measured saturations and then performed
pressure measurements during a right heart
pullback. Angiography of the right common femoral artery
demonstrated an arteriotomy above the bifurcation felt to be
suitable for closure device and we deployed a #6 French Perclose
device with adequate achievement of hemostasis.
Based on findings at diagnostic catheterization, intervention was
undertaken on the sequential vein graft. Angiomax was
administered and the vein graft was engaged with a #6 French
multipurpose guide. A BMW wire was advanced into the distal graft
and then over the BMW wire, a 6 mm spider filter wire was advanced
into the distal graft and deployed. I then advanced an Angiojet
aspiration thrombectomy catheter into the proximal stenosis and
performed aspiration thrombectomy. I advanced a BMW wire back
down and used it to measure lesion length and then returned with a
3.5 x 23 mm Xience drug-eluting stent. This stent was deployed
with two inflations up to 14 atmospheres. Following stent
deployment, we had transient no reflow that responded to removal
of the filter and intracoronary administration of nicardipine.
Following administration of nicardipine, we had no residual
stenosis in the proximal vein graft. We had TIMI-3 flow into both
the diagonal vessel and the obtuse marginal vessel and no evidence
of perforation, dissection or distal embolization. The length of
the lesion covered was 22 mm.
93461 26 59
92980
75710 26 59
92973?
After obtaining informed consent, the patient was transported in
the nonsedated condition to the cardiac catheterization suite. The
patient was prepped and draped in a sterile fashion. Lidocaine 2%
was used to infiltrate the skin and subcutaneous tissue overlying
the left common femoral artery. A #6 French introducer sheath was
placed in the left common femoral artery utilizing the Seldinger
technique. After obtaining access in the left common femoral
artery and placing a short #6 French sheath, we were unable to
pass a standard J-wire up the iliac artery due to tortuosity. We
performed angiography and found an ectatic region with a tight
hairpin bend that was impeding our flow. We therefore changed our
J-wire for a Wholey wire with which we were able to negotiate the
extreme tortuosity in the left common iliac artery. Once the
Wholey wire was advanced, we removed our #6 French short sheath
and exchanged it for a #6 French Arrow Superflex sheath with which
we advanced this under fluoroscopic guidance into the descending
aorta. I then used a #6 French multipurpose catheter to cross the
aortic valve and performed a hand injection of the left ventricle.
We measured end-diastolic pressure and pullback across the aortic
valve. The multipurpose catheter was then used for native right
coronary artery, saphenous vein angiography, and was exchanged for
a JL-5 catheter which was used to engage the left main coronary
artery for angiography. We used a mammary catheter to engage the
left internal mammary artery. Due to difficulty extending a
standard glide wire and Wholey wire up the right subclavian
artery, we returned with a #5 French VTK catheter with which we
engaged the origin of the right subclavian artery. I then
advanced a glide wire into the distal subclavian and over this
advanced my VTK catheter. I then exchanged out the glide wire for
a long Wholey wire and placed an LCB catheter into the right
subclavian artery. With this, we were able to perform right
internal mammary angiography.
After accessing the common femoral artery, attention was turned to
the common femoral vein. Utilizing the Seldinger technique, a #7
French introducer sheath was placed in the common femoral vein.
The #7 French balloon-tipped PA catheter was introduced into the
sheath, the balloon was inflated and the catheter was manipulated
into the pulmonary artery. The wedge position was confirmed by
pressure tracing and the balloon was deflated. Thermodilution
cardiac outputs were then performed. After completion of the
outputs, the pigtail catheter was advanced across the aortic valve
and simultaneous pressures were obtained. The balloon on the Swan
catheter was inflated and simultaneous LV wedge pressure was
obtained followed by sequential pressures during a PA catheter
pullback. These pressures include simultaneous LV/PA, LV/RV, and
LV/right atrial pressures. The balloon catheter was subsequently
removed and we proceeded with LV-gram and coronary angiography.
We then proceeded with the intervention as described below.
Following completion of our intervention, we performed a standard
right heart catheterization utilizing a Swan Ganz balloon
floatation catheter which we advanced under fluoroscopic guidance
into the wedge position, measured saturations and then performed
pressure measurements during a right heart
pullback. Angiography of the right common femoral artery
demonstrated an arteriotomy above the bifurcation felt to be
suitable for closure device and we deployed a #6 French Perclose
device with adequate achievement of hemostasis.
Based on findings at diagnostic catheterization, intervention was
undertaken on the sequential vein graft. Angiomax was
administered and the vein graft was engaged with a #6 French
multipurpose guide. A BMW wire was advanced into the distal graft
and then over the BMW wire, a 6 mm spider filter wire was advanced
into the distal graft and deployed. I then advanced an Angiojet
aspiration thrombectomy catheter into the proximal stenosis and
performed aspiration thrombectomy. I advanced a BMW wire back
down and used it to measure lesion length and then returned with a
3.5 x 23 mm Xience drug-eluting stent. This stent was deployed
with two inflations up to 14 atmospheres. Following stent
deployment, we had transient no reflow that responded to removal
of the filter and intracoronary administration of nicardipine.
Following administration of nicardipine, we had no residual
stenosis in the proximal vein graft. We had TIMI-3 flow into both
the diagonal vessel and the obtuse marginal vessel and no evidence
of perforation, dissection or distal embolization. The length of
the lesion covered was 22 mm.
