Need help with CPT/ICD 10 codes for this op note. Have not coded a PFO before. The RHC did document the pressures. Thanks for looking.
A right heart catheterization with a 6-french swan ganz catheter was carried out. The right heart catheter was then removed. Next a 8-french intracardiac echo catheter was advanced into the right atrium. The structures including the interatrial septum, coronary sinus, superior vena cava, tricuspid valve were evaluated. Next, the PFO was crossed with a multipurpose catheter. The catheter was directed into the left upper pulmonary vein. Next a 24mm sizing balloon was advanced across the PFO. The PFO length/diameter was evaluated by ICE and angiographically. Consequently, a 30mm Gore Cardioform septal occlude was chosen and prepped according to manufacturers guidelines.
The occluder was chosen and prepped according to manufactures guidelines. The occluder was advanced under fluoroscopic guidance and deployed in 2 separate steps uneventfully. Re-interrogation with ICE showed a well seated device without any Impingement on surrounding structures, including the coronary sinus, SVC and AV valves. There was no spontaneous flow across the occlude by color Doppler and repeat injections with agitated saline did not show any residual shunt.
Following confirmation of appropriate placement the device was then released. Re-interrogation with ICE again demonstrated a stable position with the right atrial disc entirely on the right side and the left atrial disc entirely on the left side of the interatrial septum with no impingement on the surrounding structures.
A right heart catheterization with a 6-french swan ganz catheter was carried out. The right heart catheter was then removed. Next a 8-french intracardiac echo catheter was advanced into the right atrium. The structures including the interatrial septum, coronary sinus, superior vena cava, tricuspid valve were evaluated. Next, the PFO was crossed with a multipurpose catheter. The catheter was directed into the left upper pulmonary vein. Next a 24mm sizing balloon was advanced across the PFO. The PFO length/diameter was evaluated by ICE and angiographically. Consequently, a 30mm Gore Cardioform septal occlude was chosen and prepped according to manufacturers guidelines.
The occluder was chosen and prepped according to manufactures guidelines. The occluder was advanced under fluoroscopic guidance and deployed in 2 separate steps uneventfully. Re-interrogation with ICE showed a well seated device without any Impingement on surrounding structures, including the coronary sinus, SVC and AV valves. There was no spontaneous flow across the occlude by color Doppler and repeat injections with agitated saline did not show any residual shunt.
Following confirmation of appropriate placement the device was then released. Re-interrogation with ICE again demonstrated a stable position with the right atrial disc entirely on the right side and the left atrial disc entirely on the left side of the interatrial septum with no impingement on the surrounding structures.
