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Operations performed:
1. Left heart catheterization
2. Selective right and left coronary arteriogram
3. LV gram
4. Abdominal aortogram with DSA
5. Selective right femoral arteriogram
6. Mynx closure of the arteriotomy
Reason for the procedure: The patient has a long history of peripheral vascular disease, also has a history of hypertension for many years, had a nuclear scan done at the office several months ago that was normal; however, she came to the office complaining of retrosternal chest pain with radiation to the neck. The pain was relieved with nitroglycerin. Because of the above findings, history of hypertension, and also the history of the type of pain she was having, it was decided to proceed with cardiac catheterization.
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 right femoral artery without any difficulty. Through this needle, a J-wire was utilized, but it was impossible to pass a wire past the proximal iliac. Therefore, a Wholey wire was tried to cross the area in the proximal RFA; however, it was not possible to do that with this wire. The wire was then changed for a 0.035 glidewire. The glidewire was able to cross the lesion and go to the distal aorta. After this was done, a #6-French sheath was placed in the right femoral artery without any difficulty, and a right femoral artery angiogram was performed. The first catheter utilized was a JL4. It was placed in the ostium of the left coronary and several injections of dye of the left coronary artery were obtained. Then, the catheter was changed for a regular J-wire. The next catheter utilized was a JL4. This was placed in the ostium of the right coronary artery and several views of the right coronary artery were obtained. This catheter was withdrawn over the wire. After this was done, an angled pigtail was placed in the aorta over the wire. This catheter was advanced into the left ventricle with hemodynamic monitoring. After the catheter was in the left ventricle, left ventriculogram was performed.
The catheter was withdrawn with pullback into the aorta under hemodynamic monitoring. After this was done, the catheter was placed in the mid abdominal aorta and an abdominal aortogram was performed with DSA. Then a second abdominal aortogram was performed to better visualize the ostium of both iliac arteries. The catheter was then pulled back and there was a 602 mm gradient across the lesion in the ostium of the right iliac. The catheter was withdrawn over the wire. After this was done, Mynx closure was done to close the arthrotomy.
Hemodynamic Findings: The pressure inside the aorta was 158 with a diastolic of 52 and mean diastolic of 93. The aortic pressure was 166 with again diastolic of 5 to 7.
Angiographic Findings: The left main was injected in several views, i.e. it was injected in the AP, AP caudal, RAO caudal, LAO caudal, AP cranial, and LAO caudal and this showed a plaque in the LAD. The circumflex was large and had three OMs. The RCA was also injected in several views i.e. in the LAO, LAO cranial, and AP and this showed plaques in the mid portion of the RCA. Because of the significant amount of sbdominal disease, it was decided to perform abdominal aortogram under DSA. This showed a very small right kidney with small artery to it and the left renal was normal with no evidence of disease in the left renal artery. There was diffuse disease in the abdominal aorta with significant calcification. Also, the pigtail was then pullback and placed above the iliacs and a second abdominal aortogram was performed on the DSA. This showed diffuse disease of both proximal iliacs; however, the right iliac showed a 90% stenosis in the proximal portion and there was 60 mm gradient across the lesion. The left iliac exhibit a 70% stenosis in the proximal portion. There was a calcified vessel in the common femoral that was seen in the DSA that was drawn on the bilateral iliac arteriogram.
It is my feeling at this time that the patient should be continued on her medications. She will probably later undergo PT of RCA and stent of the right iliac and also of the left iliac at a later date. The patient had closure of the arteriotomy with Mynx closure with good results.
The patient tolerated the procedure well. The EBL was less than 30 CC. She was sent to the recovery room in stable condition.
The doctor states the patient has CAD, PVD, and Stricture of Artery.
Would I code this as:
93458-26, dx. 414.00
75630-26-59, dx. 443.9
75710-26-59, dx. 447.1
Does this look correct????? Thank you.
Operations performed:
1. Left heart catheterization
2. Selective right and left coronary arteriogram
3. LV gram
4. Abdominal aortogram with DSA
5. Selective right femoral arteriogram
6. Mynx closure of the arteriotomy
Reason for the procedure: The patient has a long history of peripheral vascular disease, also has a history of hypertension for many years, had a nuclear scan done at the office several months ago that was normal; however, she came to the office complaining of retrosternal chest pain with radiation to the neck. The pain was relieved with nitroglycerin. Because of the above findings, history of hypertension, and also the history of the type of pain she was having, it was decided to proceed with cardiac catheterization.
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 right femoral artery without any difficulty. Through this needle, a J-wire was utilized, but it was impossible to pass a wire past the proximal iliac. Therefore, a Wholey wire was tried to cross the area in the proximal RFA; however, it was not possible to do that with this wire. The wire was then changed for a 0.035 glidewire. The glidewire was able to cross the lesion and go to the distal aorta. After this was done, a #6-French sheath was placed in the right femoral artery without any difficulty, and a right femoral artery angiogram was performed. The first catheter utilized was a JL4. It was placed in the ostium of the left coronary and several injections of dye of the left coronary artery were obtained. Then, the catheter was changed for a regular J-wire. The next catheter utilized was a JL4. This was placed in the ostium of the right coronary artery and several views of the right coronary artery were obtained. This catheter was withdrawn over the wire. After this was done, an angled pigtail was placed in the aorta over the wire. This catheter was advanced into the left ventricle with hemodynamic monitoring. After the catheter was in the left ventricle, left ventriculogram was performed.
The catheter was withdrawn with pullback into the aorta under hemodynamic monitoring. After this was done, the catheter was placed in the mid abdominal aorta and an abdominal aortogram was performed with DSA. Then a second abdominal aortogram was performed to better visualize the ostium of both iliac arteries. The catheter was then pulled back and there was a 602 mm gradient across the lesion in the ostium of the right iliac. The catheter was withdrawn over the wire. After this was done, Mynx closure was done to close the arthrotomy.
Hemodynamic Findings: The pressure inside the aorta was 158 with a diastolic of 52 and mean diastolic of 93. The aortic pressure was 166 with again diastolic of 5 to 7.
Angiographic Findings: The left main was injected in several views, i.e. it was injected in the AP, AP caudal, RAO caudal, LAO caudal, AP cranial, and LAO caudal and this showed a plaque in the LAD. The circumflex was large and had three OMs. The RCA was also injected in several views i.e. in the LAO, LAO cranial, and AP and this showed plaques in the mid portion of the RCA. Because of the significant amount of sbdominal disease, it was decided to perform abdominal aortogram under DSA. This showed a very small right kidney with small artery to it and the left renal was normal with no evidence of disease in the left renal artery. There was diffuse disease in the abdominal aorta with significant calcification. Also, the pigtail was then pullback and placed above the iliacs and a second abdominal aortogram was performed on the DSA. This showed diffuse disease of both proximal iliacs; however, the right iliac showed a 90% stenosis in the proximal portion and there was 60 mm gradient across the lesion. The left iliac exhibit a 70% stenosis in the proximal portion. There was a calcified vessel in the common femoral that was seen in the DSA that was drawn on the bilateral iliac arteriogram.
It is my feeling at this time that the patient should be continued on her medications. She will probably later undergo PT of RCA and stent of the right iliac and also of the left iliac at a later date. The patient had closure of the arteriotomy with Mynx closure with good results.
The patient tolerated the procedure well. The EBL was less than 30 CC. She was sent to the recovery room in stable condition.
The doctor states the patient has CAD, PVD, and Stricture of Artery.
Would I code this as:
93458-26, dx. 414.00
75630-26-59, dx. 443.9
75710-26-59, dx. 447.1
Does this look correct????? Thank you.
