Patient had LHC and SCA 03/10 and on 03/24 was scheduled for STENT but Dr decided on only doing FFR of LAD and DIAGONAL 1 how would this be billed with
no cath since the FFR is an add on code op report reads
1. Selective coronary angiography
2. FFR LAD
3. FFR D1
4. Right femoral angiogram
Procedure Details
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient concurred with the proposed plan, giving informed consent. Patient was brought to the cath lab after IV hydration was begun and oral premedication was given. She was further sedated with fentanyl and midazolam. She was prepped and draped in the usual manner. Using the modified Seldinger access technique, a 7 French sheath was placed in the right femoral artery. This was then exchanged for a long 7 french sheath given the patient's iliac tortuosity. Following sheath placement, anticoagulation was performed with angiomax and ACT checks were undertaken per protocol.
Coronary Angiography was then undertaken. A XB 3.5 guiding catheter was advanced over a J-tipped guidewire and ultimately seated in the Left Main Coronary Artery. Multiple attempts were made to cross the LAD lesion with the FFR wire, however we were unable to cross the lesion with the current guide position. The decision was made to exchange for an XB 3 guide. Decision made to determine physiologic significance of the left anterior descending lesion and D! documented during prior diagnostic catheterization. An Aeris pressure wire was opened, prepped with heparinized saline, and calibrated. The pressure wire was then advanced via the guiding catheter until the wire transducer reached the ostium of the catheter. At this point the pressure readouts were equalized to ensure accuracy of results. The wire was then advanced distal to the target lesion. Baseline FFR was obtained of 96 % of the LAD lesion and 89% for the D1. Subsequently, Adenosine Infusion 140mcg/kg/min was given Peripheral intravenous. Additional FFR results of 88 % for the LAD and 81% for the D1 after Infusion 140mcg/kg/min were documented. The target lesion was determined to be not significant . The pressure wire was then removed. At this point, an intervention was not deemed necessary. The guiding catheter was removed over a wire.
Interventions:
FFR LAD/D1 with results 0.88/0.81 respectively, no PCI performed based on FFR results
no cath since the FFR is an add on code op report reads
1. Selective coronary angiography
2. FFR LAD
3. FFR D1
4. Right femoral angiogram
Procedure Details
The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient concurred with the proposed plan, giving informed consent. Patient was brought to the cath lab after IV hydration was begun and oral premedication was given. She was further sedated with fentanyl and midazolam. She was prepped and draped in the usual manner. Using the modified Seldinger access technique, a 7 French sheath was placed in the right femoral artery. This was then exchanged for a long 7 french sheath given the patient's iliac tortuosity. Following sheath placement, anticoagulation was performed with angiomax and ACT checks were undertaken per protocol.
Coronary Angiography was then undertaken. A XB 3.5 guiding catheter was advanced over a J-tipped guidewire and ultimately seated in the Left Main Coronary Artery. Multiple attempts were made to cross the LAD lesion with the FFR wire, however we were unable to cross the lesion with the current guide position. The decision was made to exchange for an XB 3 guide. Decision made to determine physiologic significance of the left anterior descending lesion and D! documented during prior diagnostic catheterization. An Aeris pressure wire was opened, prepped with heparinized saline, and calibrated. The pressure wire was then advanced via the guiding catheter until the wire transducer reached the ostium of the catheter. At this point the pressure readouts were equalized to ensure accuracy of results. The wire was then advanced distal to the target lesion. Baseline FFR was obtained of 96 % of the LAD lesion and 89% for the D1. Subsequently, Adenosine Infusion 140mcg/kg/min was given Peripheral intravenous. Additional FFR results of 88 % for the LAD and 81% for the D1 after Infusion 140mcg/kg/min were documented. The target lesion was determined to be not significant . The pressure wire was then removed. At this point, an intervention was not deemed necessary. The guiding catheter was removed over a wire.
Interventions:
FFR LAD/D1 with results 0.88/0.81 respectively, no PCI performed based on FFR results