Please help me. I am not sure that I am coding this correctly and/or if I am missing any codes. I coded 93460-26, 75710-26. I am not sure if I need any other modifiers on the 75710 (59?) Thank you for helping.
Here is the Op Report:
THe risks, benefits....
THe patient received Benadryl/Valium as preoperative medicatino prior to the catherization procedure. He was brought to thable. A peripheral IV was started and maintained KVO with 5% D/W. Electrocardiographic leads were attached to the patient and continuous electrocardiographic monitoring was maintained throughtout the procedure.
Sterile set up and calibration of pressure monitoring equipment was carried out. Sterile technique was maintained by all personnel throughout the procedure. An ongoing record of the procedure was maintained by the nursing personnel.
The skin over the right femoral fossa at the inguinal ligament was prepped using a sterile technique, draped and infiltrated with 1%Xylocaine plain anesthesia.
Using the Seldinger technique, the right femoral vein was entered percutaneously through the area of local anesthesia. THe patient tolerated this well. Through this site a #7F Swan Ganz catheter was introcuced and advanced antegrade under fluroscopic guidance through the vena cava, through the right heart and into the pulmonary artery. Pressures were then measured and recorded in the pulmonary capillary wedge position and pulmonary artery, and blood was obtained for oxygen analysis.
Cardiac output was then measured and recorded by the Thermodilution technique.
Pressures were then recorded during continuous pull back from the pulmonary artery to the right atrium and blood obtained for oxygen analysis as appropriate. THe patient tolerated these procedures well.
The right femoral artery was entered precutaneously by Seldinger technique near the level of the inguinal ligament through an area of local 1% Xylocaine anesthesia. The artery was dilated to #6 French size over a guidewire and the dilator removed and the guidewire cleaned.
Over the guidewire, a flushed #6 French pigtail Cordis catheter was then advanced into the arterial system. THe catheter was aspirated, the system checked and cleared of bubbles and thoroughly flused with heparinized saline. Under fluroscopic control this catheer was then cautiously advanced retrograde to the ascending aorta and then advanced retrograde into the leftventricle. Pressures were recorded fom the left ventricle and blood taken for oxygen analysis. A test injection of Omnipaque was made and no adverse reaction observed.
Left ventriculography was performed in the 30 degree RAO projection using 30 cc of Omnipaque. After each injection the patient was interrogated and inspected and it was determined that he had tolerated the procedure well. Pressures were again recorded from the left ventricle and by pull back into the aortic root.
THe catheter and tubings were repeatedly inspected for bubbles and frequently aspirated and flushed with small amounts of heparinized 0.9% saline solution to insrue patency and proper functin.
THe pigtail catheer was then exchanged sequentially for sterile, flushed #6 French Judkins right and left coronary catheters and 0.4 Nitroglycerin was administered sublingualy. Cine angiograms were obtained of the left and right coronary arteries using hand injections of 2-10 ml. of Omnipaque in multiple projections. THe patient tolerated the procedure well.
Right femoral angiogram with unilateral run off was performed secondary to leg tiredness and the reason for his falling to evaluate for peripheral arterial disease. The angiogram revealed excellent opacification of the superficial femoral artery and profundus with no severe peripheral arterial disease noted.
The right foot and leg were inspected and found to be warm, well perfused and with an adequate pedal pulse. The catheters were then withdrawn Perclose device was administered without difficulty for hemostasis. The right foot and groin were again inspected to insure that hemostasis had been obtained and that the pedal pulses were unchanged from the pre=operative state. A sterile bandage was applied to the puncture site. An IV ramained in place, maintained at KVO with 5% D/W
Post angiographic instructions......
Here is the Op Report:
THe risks, benefits....
THe patient received Benadryl/Valium as preoperative medicatino prior to the catherization procedure. He was brought to thable. A peripheral IV was started and maintained KVO with 5% D/W. Electrocardiographic leads were attached to the patient and continuous electrocardiographic monitoring was maintained throughtout the procedure.
Sterile set up and calibration of pressure monitoring equipment was carried out. Sterile technique was maintained by all personnel throughout the procedure. An ongoing record of the procedure was maintained by the nursing personnel.
The skin over the right femoral fossa at the inguinal ligament was prepped using a sterile technique, draped and infiltrated with 1%Xylocaine plain anesthesia.
Using the Seldinger technique, the right femoral vein was entered percutaneously through the area of local anesthesia. THe patient tolerated this well. Through this site a #7F Swan Ganz catheter was introcuced and advanced antegrade under fluroscopic guidance through the vena cava, through the right heart and into the pulmonary artery. Pressures were then measured and recorded in the pulmonary capillary wedge position and pulmonary artery, and blood was obtained for oxygen analysis.
Cardiac output was then measured and recorded by the Thermodilution technique.
Pressures were then recorded during continuous pull back from the pulmonary artery to the right atrium and blood obtained for oxygen analysis as appropriate. THe patient tolerated these procedures well.
The right femoral artery was entered precutaneously by Seldinger technique near the level of the inguinal ligament through an area of local 1% Xylocaine anesthesia. The artery was dilated to #6 French size over a guidewire and the dilator removed and the guidewire cleaned.
Over the guidewire, a flushed #6 French pigtail Cordis catheter was then advanced into the arterial system. THe catheter was aspirated, the system checked and cleared of bubbles and thoroughly flused with heparinized saline. Under fluroscopic control this catheer was then cautiously advanced retrograde to the ascending aorta and then advanced retrograde into the leftventricle. Pressures were recorded fom the left ventricle and blood taken for oxygen analysis. A test injection of Omnipaque was made and no adverse reaction observed.
Left ventriculography was performed in the 30 degree RAO projection using 30 cc of Omnipaque. After each injection the patient was interrogated and inspected and it was determined that he had tolerated the procedure well. Pressures were again recorded from the left ventricle and by pull back into the aortic root.
THe catheter and tubings were repeatedly inspected for bubbles and frequently aspirated and flushed with small amounts of heparinized 0.9% saline solution to insrue patency and proper functin.
THe pigtail catheer was then exchanged sequentially for sterile, flushed #6 French Judkins right and left coronary catheters and 0.4 Nitroglycerin was administered sublingualy. Cine angiograms were obtained of the left and right coronary arteries using hand injections of 2-10 ml. of Omnipaque in multiple projections. THe patient tolerated the procedure well.
Right femoral angiogram with unilateral run off was performed secondary to leg tiredness and the reason for his falling to evaluate for peripheral arterial disease. The angiogram revealed excellent opacification of the superficial femoral artery and profundus with no severe peripheral arterial disease noted.
The right foot and leg were inspected and found to be warm, well perfused and with an adequate pedal pulse. The catheters were then withdrawn Perclose device was administered without difficulty for hemostasis. The right foot and groin were again inspected to insure that hemostasis had been obtained and that the pedal pulses were unchanged from the pre=operative state. A sterile bandage was applied to the puncture site. An IV ramained in place, maintained at KVO with 5% D/W
Post angiographic instructions......