I need help please..... Doc did LHC w/coronaries, also He says PTCA/stent of RCA x2, plus coronary thrombectomy of RCA.....I am not for sure on this...
Procedure in detail:
After consent, pt was brought to cath lab, numbed r. groin. then sheath inserted in RCFA, then selective coronary angiography was performed. Pigtail cath was prolapsed across AV at conclusion of this case. Contrast ventriculogram was performed in RAO projection. Hemodynamics were assesed w/pullback across AV. PTCA w/coronary thrombectomy and balloon angioplast and sten placement was performed in RCA. Diagnostic coronary angiography was performed. Then decision was made to proceed to PCI/stenting of RCA.
Angiographic findings:
RCA 99% stenosis w/filling defect in proximal third of AVgroove, 90-95% stenosis in md AV groove segment. Vessel is very large measures 3.5 mm in dameter throughout RCA. The distal RCA gives rise to PDA and multiple distal segments. The proximal RCA near the ostium is about 3.5-4 mm vessel w/out any obstructive disease.
LM angiographically normal, free of disease
LCA is larege vessel w/diffuse irregularities, no significant stenoses are detected. Mild irregularity of high lateral branch. No critical lesions are detected.
LAD has mid irregularities in proximal thrid to mid LAD w/50% focal stenossis near 1st septal perforator.
Contrast ventriculogram demonstrates basilar inferior wall segmental hypokinesis to akinesis, mild hypokinesis w/lv fraction of 45%.
Hemodynamics: LV end diastolic pressure was around 15 mmhg.
Conclusion: REcent IWMI, most likely completed prior to presentatin at hospital w/residual high grade sequntial stenosis and ulcerated plaque in proximal to mid portion of RCA. Given his symptoms and EKG changes, he would clearly benefit from PCI. Mild to mod disease of proximal and mid LAD.... 80% focal stenosis of moderate side diagonal branch. MIld irrregularities of Circumflex artery. Ischemic LV dysfunction w/LV ejection fraction of 45%
PCI report: Following above findings, cath was advanced int RC ostium. A whisper wire was advanced into distal RCA. Initially there was intracoronary thrombectomy performed with a Pronto cath of the proximal lesion. Pt was given heparin prior to coming to cath lab. Pronto cath was advanced into proximal lesin and coronary thrombectomy was performed Following this a balloon angioplasty was performed w/3xmmx185mm long noncompliant balloon. Then stents were deployed, a Medtronic Resolute drug eluting stnet was positioned in distal lesion. A second 22mx3.5m stent was positioned in more proximal lesion. The 2 overlapped. Final post implantatin inflations were performed w/3.5x25 NC TREK balloon taken to 20 atmospheres insid stent margins for several inflatins. Angiography was repeated demonstrating excellent result with 0 to negative 10% residual throughout full expansion fo stented segments. No complication.
I think should code: 93458 26-59 , 92928 RC and 92973..... Dr says PTCA x2 and RCA x2 92920 RC twice and 92928 RC twice?
Any suggestions
Procedure in detail:
After consent, pt was brought to cath lab, numbed r. groin. then sheath inserted in RCFA, then selective coronary angiography was performed. Pigtail cath was prolapsed across AV at conclusion of this case. Contrast ventriculogram was performed in RAO projection. Hemodynamics were assesed w/pullback across AV. PTCA w/coronary thrombectomy and balloon angioplast and sten placement was performed in RCA. Diagnostic coronary angiography was performed. Then decision was made to proceed to PCI/stenting of RCA.
Angiographic findings:
RCA 99% stenosis w/filling defect in proximal third of AVgroove, 90-95% stenosis in md AV groove segment. Vessel is very large measures 3.5 mm in dameter throughout RCA. The distal RCA gives rise to PDA and multiple distal segments. The proximal RCA near the ostium is about 3.5-4 mm vessel w/out any obstructive disease.
LM angiographically normal, free of disease
LCA is larege vessel w/diffuse irregularities, no significant stenoses are detected. Mild irregularity of high lateral branch. No critical lesions are detected.
LAD has mid irregularities in proximal thrid to mid LAD w/50% focal stenossis near 1st septal perforator.
Contrast ventriculogram demonstrates basilar inferior wall segmental hypokinesis to akinesis, mild hypokinesis w/lv fraction of 45%.
Hemodynamics: LV end diastolic pressure was around 15 mmhg.
Conclusion: REcent IWMI, most likely completed prior to presentatin at hospital w/residual high grade sequntial stenosis and ulcerated plaque in proximal to mid portion of RCA. Given his symptoms and EKG changes, he would clearly benefit from PCI. Mild to mod disease of proximal and mid LAD.... 80% focal stenosis of moderate side diagonal branch. MIld irrregularities of Circumflex artery. Ischemic LV dysfunction w/LV ejection fraction of 45%
PCI report: Following above findings, cath was advanced int RC ostium. A whisper wire was advanced into distal RCA. Initially there was intracoronary thrombectomy performed with a Pronto cath of the proximal lesion. Pt was given heparin prior to coming to cath lab. Pronto cath was advanced into proximal lesin and coronary thrombectomy was performed Following this a balloon angioplasty was performed w/3xmmx185mm long noncompliant balloon. Then stents were deployed, a Medtronic Resolute drug eluting stnet was positioned in distal lesion. A second 22mx3.5m stent was positioned in more proximal lesion. The 2 overlapped. Final post implantatin inflations were performed w/3.5x25 NC TREK balloon taken to 20 atmospheres insid stent margins for several inflatins. Angiography was repeated demonstrating excellent result with 0 to negative 10% residual throughout full expansion fo stented segments. No complication.
I think should code: 93458 26-59 , 92928 RC and 92973..... Dr says PTCA x2 and RCA x2 92920 RC twice and 92928 RC twice?
Any suggestions
