amym
Guest
Is it still appropriate to bill as 93458?
PROCEDURES PERFORMED:
-- Left heart catheterization.
-- Left coronary angiography.
RECOMMENDATIONS:
The patient should continue with the present medications.
The patient's anti-anginal regimen should be further intensified.
INDICATIONS: Angina/MI: stable angina.
CORONARY VESSELS: The coronary circulation is right dominant. Small
non-flow limiting dissection noted at the distal LMCA/LAD ostium. This is
unchanged from previous image from yesterday and is felt to be stable.
Ramus lesion is also unchanged and since it is a small vessel, best
treatment option is medical therapy. Mid LAD: There was a 100 % stenosis.
1st diagonal: There was a 99 % stenosis. Mid circumflex: Angiography
showed minor luminal irregularities.
PROCEDURE: The risks and alternatives of the procedures and conscious
sedation were explained to the patient and informed consent was obtained.
The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile
fashion.
-- Right femoral artery access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Left heart catheterization. A catheter was advanced to the ascending
aorta. After recording ascending aortic pressure, the catheter was
advanced across the aortic valve and left ventricular pressure was
recorded. Imaging was performed using an RAO projection.
-- Left coronary artery angiography. A catheter was advanced to the aorta
and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
COMPLICATIONS:
There were no adverse outcomes.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
Test started at 09:48. Test concluded at 10:00. RADIATION EXPOSURE:
Fluoroscopy time: 0.7 min.
HEMOSTASIS:
The sheath was removed. The site was compressed manually. Hemostasis was
successful.
PROCEDURES PERFORMED:
-- Left heart catheterization.
-- Left coronary angiography.
RECOMMENDATIONS:
The patient should continue with the present medications.
The patient's anti-anginal regimen should be further intensified.
INDICATIONS: Angina/MI: stable angina.
CORONARY VESSELS: The coronary circulation is right dominant. Small
non-flow limiting dissection noted at the distal LMCA/LAD ostium. This is
unchanged from previous image from yesterday and is felt to be stable.
Ramus lesion is also unchanged and since it is a small vessel, best
treatment option is medical therapy. Mid LAD: There was a 100 % stenosis.
1st diagonal: There was a 99 % stenosis. Mid circumflex: Angiography
showed minor luminal irregularities.
PROCEDURE: The risks and alternatives of the procedures and conscious
sedation were explained to the patient and informed consent was obtained.
The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile
fashion.
-- Right femoral artery access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Left heart catheterization. A catheter was advanced to the ascending
aorta. After recording ascending aortic pressure, the catheter was
advanced across the aortic valve and left ventricular pressure was
recorded. Imaging was performed using an RAO projection.
-- Left coronary artery angiography. A catheter was advanced to the aorta
and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
COMPLICATIONS:
There were no adverse outcomes.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
Test started at 09:48. Test concluded at 10:00. RADIATION EXPOSURE:
Fluoroscopy time: 0.7 min.
HEMOSTASIS:
The sheath was removed. The site was compressed manually. Hemostasis was
successful.
