OPENSHAW
Guru
Does anybody know how this would be coded:
The attached report of procedure reads:
Operations performed:
1. Left heart cath
2. Selective right and left coronary arteriogram
3. Selective saphenous vein arteriogram to the right coronary artery
4. Selective saphenous vein arteriogram to the obtuse marginal 1 and
obtuse marginal 2
5. Selective saphenous vein arteriogram to the diagonal
6. Selective subclavian arteriogram
7. Selective left internal mammary artery arteriogram
8. Left ventriculogram
9. Selective left iliac arteriogram with distal follow through
10. Selective right iliac arteriogram with distal follow through
reason for the procedure: The patient has a long history of coronary artery disease and bypass surgery several years ago. Most recently was having episodes of chest pain, underwent stress test at the office that was abnormal, and was complaining also of leg pain and because of the leg pain he underwent an arterial doppler study of both lower extremities that shows severe peripheral vascular disease. Because of the findings, it was decided to proceed with a cardiac catheterization and distant vessel arteriogram.
Description of the procedure: After informed consent, the right groin was prepped in the usual sterile fashion. After this was done, a cook needle was placed in the femoral artery without any difficulty. Through this needle, a j wire was utilized, and a 6 french sheath was placed in the right femoral artery without any difficulty. Through this sheath, several catheters were utilized. The 1st catheter utilized was a jl4. This was placed in the ostium of the left coronary. Several views of the left coronary artery were obtained. This catheter was then withdrawn over the wire. The next catheter utilized was a judkins right. This was placed in the ostium of the right coronary and several views of the right coronary were obtained. This catheter was rotated and was placed in the ostium of the obtuse marginal branch of the saphenous vein graft to the obtuse marginal graft and there it was injected in several views. This catheter was then again rotated and injected in ostium of the saphenous vein graft to the diagonal. It was also injected in several views. This catheter was then rotated and was placed in the subclavian and a subclavian arteriogram was performed. After this was done, the catheter was advanced and it was placed in the lima and a lima arteriogram was performed. The catheter was then withdrawn over the wire. Next catheter utilized was a omniflush. The omniflush was placed in the iliac artery utilizing a whooley wire. Selective iliac arteriogram was performed with dsa with distal follow through. This catheter was pulled back and placed in the right iliac and right iliac arteriogram was performed with the follow through under dsa. This catheter was withdrawn over the wire.
Hemodynamic findings: Blood pressure was 140/80 in the aorta and in the lv was 140 with end-diastolic of approximately 18-20.
Angiographic findings: The left coronary was injected in several views; that is, it was injected in the ap caudal, rao caudal, rao cranial, lao cranial, ap cranial, lao caudal, and these showed about 50% stenosis of the proximal lad and 90% stenosis of the diagonal 1 and diffuse disease in the distal lad. The circumflex exhibited 100% obstruction of the om-1 and om-2 and there was diffuse disease in the main circumflex with an approximately 60% to 70% stenosis in the distal obtuse marginal branch of the circumflex. The rca was also injected in several views, that is in the ap, in lao and lao caudal and it showed 100% obstruction of the pda, of the distal rca and 90% obstruction in the mid portion of the rca and a 60% obstruction of the proximal rca. The saphenous vein graft to the rca was also injected in several views, that is in the lao, lao cranial and it showed patent graft to the pda that also illuminated the posterior ventricular branch. The injection in the rca graft also showed the pda at the posterior ventricular branch. The saphenous vein graft to the obtuse marginal branch-1 and obtuse marginal branch-2 were injected in several views, that is in the ap and the lao, ap and rao, and these showed a patent double graft to the obtuse marginal-1 and obtuse marginal-2. The saphenous vein graft to the diagonal was also injected in several views, that is in the lao, ap and rao and it showed a patent graft to the diagonal. The subclavian arteriogram was performed and it showed diffuse obstructive disease of the subclavian artery. The lima was also injected in several views and it showed a 40% stenbosis in the ostial portion; however, it was patent all the way down to the lad. This was injected in several views, that is in the ap and the rao view. The lv gram was performed in the rao projection. Showed an ejection fraction of 50% with inferior akinesis. After this was done, catheter was changed to an omniflush. The omniflush catheter was placed in the proximal portion of the iliac and iliac arteriogram was performed with distal follow thought. It showed diffuse disease of the proximal iliac, diffuse disease of the sfa and 100% stenosis of the anterior tibial and the posterior tibial and diffuse 80% stenosis of the peroneal branch. That was the only branch that went all the way to the foot on the left side. The right iliac arteriogram was also injected with dsa. On the dsa this showed a diffuse disease in the ilaic, diffuse disease in the superficial femoral and 99% obstruction of the peroneal with complete obstruction of the peroneal with complete obstruction of the anterior tibial and the posterior tibial and the only artery to the foot was the peroneal on the right side, also. The lv gram shown in the rao projection showed an ejection fraction of 50% with inferior akinesis.
It is my feeling at this time the patient should undergo intervention in both legs in the future. In the interim, she will be treated medically. Patient tolerated the procedure well. The arteriotomy was closed with syvek patch, and patient was sent to the recovery room in stable condition.
WOULD THIS BE CODED AS
93459-26
75716-26-59
PT HAS DX OF PVD 443.9, CAD 414.00, S/P ACB V45.81, STRICTURE OF ARTERY 447.1
The attached report of procedure reads:
Operations performed:
1. Left heart cath
2. Selective right and left coronary arteriogram
3. Selective saphenous vein arteriogram to the right coronary artery
4. Selective saphenous vein arteriogram to the obtuse marginal 1 and
obtuse marginal 2
5. Selective saphenous vein arteriogram to the diagonal
6. Selective subclavian arteriogram
7. Selective left internal mammary artery arteriogram
8. Left ventriculogram
9. Selective left iliac arteriogram with distal follow through
10. Selective right iliac arteriogram with distal follow through
reason for the procedure: The patient has a long history of coronary artery disease and bypass surgery several years ago. Most recently was having episodes of chest pain, underwent stress test at the office that was abnormal, and was complaining also of leg pain and because of the leg pain he underwent an arterial doppler study of both lower extremities that shows severe peripheral vascular disease. Because of the findings, it was decided to proceed with a cardiac catheterization and distant vessel arteriogram.
Description of the procedure: After informed consent, the right groin was prepped in the usual sterile fashion. After this was done, a cook needle was placed in the femoral artery without any difficulty. Through this needle, a j wire was utilized, and a 6 french sheath was placed in the right femoral artery without any difficulty. Through this sheath, several catheters were utilized. The 1st catheter utilized was a jl4. This was placed in the ostium of the left coronary. Several views of the left coronary artery were obtained. This catheter was then withdrawn over the wire. The next catheter utilized was a judkins right. This was placed in the ostium of the right coronary and several views of the right coronary were obtained. This catheter was rotated and was placed in the ostium of the obtuse marginal branch of the saphenous vein graft to the obtuse marginal graft and there it was injected in several views. This catheter was then again rotated and injected in ostium of the saphenous vein graft to the diagonal. It was also injected in several views. This catheter was then rotated and was placed in the subclavian and a subclavian arteriogram was performed. After this was done, the catheter was advanced and it was placed in the lima and a lima arteriogram was performed. The catheter was then withdrawn over the wire. Next catheter utilized was a omniflush. The omniflush was placed in the iliac artery utilizing a whooley wire. Selective iliac arteriogram was performed with dsa with distal follow through. This catheter was pulled back and placed in the right iliac and right iliac arteriogram was performed with the follow through under dsa. This catheter was withdrawn over the wire.
Hemodynamic findings: Blood pressure was 140/80 in the aorta and in the lv was 140 with end-diastolic of approximately 18-20.
Angiographic findings: The left coronary was injected in several views; that is, it was injected in the ap caudal, rao caudal, rao cranial, lao cranial, ap cranial, lao caudal, and these showed about 50% stenosis of the proximal lad and 90% stenosis of the diagonal 1 and diffuse disease in the distal lad. The circumflex exhibited 100% obstruction of the om-1 and om-2 and there was diffuse disease in the main circumflex with an approximately 60% to 70% stenosis in the distal obtuse marginal branch of the circumflex. The rca was also injected in several views, that is in the ap, in lao and lao caudal and it showed 100% obstruction of the pda, of the distal rca and 90% obstruction in the mid portion of the rca and a 60% obstruction of the proximal rca. The saphenous vein graft to the rca was also injected in several views, that is in the lao, lao cranial and it showed patent graft to the pda that also illuminated the posterior ventricular branch. The injection in the rca graft also showed the pda at the posterior ventricular branch. The saphenous vein graft to the obtuse marginal branch-1 and obtuse marginal branch-2 were injected in several views, that is in the ap and the lao, ap and rao, and these showed a patent double graft to the obtuse marginal-1 and obtuse marginal-2. The saphenous vein graft to the diagonal was also injected in several views, that is in the lao, ap and rao and it showed a patent graft to the diagonal. The subclavian arteriogram was performed and it showed diffuse obstructive disease of the subclavian artery. The lima was also injected in several views and it showed a 40% stenbosis in the ostial portion; however, it was patent all the way down to the lad. This was injected in several views, that is in the ap and the rao view. The lv gram was performed in the rao projection. Showed an ejection fraction of 50% with inferior akinesis. After this was done, catheter was changed to an omniflush. The omniflush catheter was placed in the proximal portion of the iliac and iliac arteriogram was performed with distal follow thought. It showed diffuse disease of the proximal iliac, diffuse disease of the sfa and 100% stenosis of the anterior tibial and the posterior tibial and diffuse 80% stenosis of the peroneal branch. That was the only branch that went all the way to the foot on the left side. The right iliac arteriogram was also injected with dsa. On the dsa this showed a diffuse disease in the ilaic, diffuse disease in the superficial femoral and 99% obstruction of the peroneal with complete obstruction of the peroneal with complete obstruction of the anterior tibial and the posterior tibial and the only artery to the foot was the peroneal on the right side, also. The lv gram shown in the rao projection showed an ejection fraction of 50% with inferior akinesis.
It is my feeling at this time the patient should undergo intervention in both legs in the future. In the interim, she will be treated medically. Patient tolerated the procedure well. The arteriotomy was closed with syvek patch, and patient was sent to the recovery room in stable condition.
WOULD THIS BE CODED AS
93459-26
75716-26-59
PT HAS DX OF PVD 443.9, CAD 414.00, S/P ACB V45.81, STRICTURE OF ARTERY 447.1
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