Jane5711
Networker
THE PROCEDURE STATES LHC BUT THE DR ONLY DID LC ANGIOGRAPHY- CAN I CHARGE FOR THIS?
PROCEDURE PERFORMED:
1. Left heart cardiac catheterization.
2. Selective coronary artery angiography.
3. Percutaneous transluminal coronary angioplasty and stenting of the mid
left anterior descending artery with a 2.5 x 32 mm Synergy Everolimus
drug-eluting stent and percutaneous transluminal coronary angioplasty and
stenting of the proximal mid left anterior descending with a 2.5 x 20 mm
Synergy Everolimus drug-eluting stent.
4. Percutaneous transluminal coronary angioplasty and stenting of the
proximal mid left circumflex artery with a 2.5 x 38 mm Synergy Everolimus
drug-eluting stent.
INDICATIONS:
1. Coronary artery disease with a critical lesion in the mid LAD and
proximal LAD with a 95% stenosis of the mid LAD and 80% stenosis of the
proximal mid LAD.
2. Coronary artery disease with a previous history of inferolateral
myocardial infarction, angioplasty and stent of the ramus intermedius
artery, as well as previous history of significant disease of the right
coronary artery and previous history of disease in the left circumflex
artery and left anterior descending artery and diagonal branch.
3. Lateral wall ischemia and ischemic heart disease.
PROCEDURE IN DETAIL: After the informed consent was obtained, the patient was
prepped and draped in the usual sterile fashion. A 2% lidocaine was used for
local anesthesia in the right groin. Vascular access was obtained in the
right femoral artery. Over a guidewire, a 6-French long angiographic sheath
was placed in the right femoral artery.
A 6-French XB 3.5 guide without side holes was used to engage the left
coronary artery.
Left coronary artery angiography was performed.
A 0.014 Asahi Sion blue wire was used to cross the lesion in the proximal mid
LAD. A 2.5 x 30 mm balloon was used to dilate the lesion in the proximal mid
LAD at 12 atmospheres. The balloon was then removed.
Then, a 2.5 x 32 mm Synergy Everolimus drug-eluting stent was advanced in the
mid LAD and was deployed in the mid LAD at 14 atmospheres with good results.
The stent balloon was removed.
Then, a 2.5 x 20 mm Synergy Everolimus drug-eluting stent was advanced in the
proximal mid LAD and was deployed across the origin of the diagonal branch
into the mid LAD overlapping the previously placed stent and the stent was
deployed at 18 atmospheres with good results. The stent balloon was removed.
Final angiographic images were obtained. The set was then changed.
Then, a 0.014 Asahi Sion blue wire was removed and was used to cross the
lesion in the proximal mid left circumflex artery.
A 2.5 x 30 mm balloon was advanced over this and was used to dilate the lesion
in the proximal mid left circumflex artery at 8 atmospheres. The balloon was
then removed and then a 2.5 x 38 mm Synergy Everolimus drug-eluting stent was
advanced in the proximal mid left circumflex artery and was deployed at 12
atmospheres with good results. Stent balloon was removed. Final angiographic
images were obtained. The set was changed. Guidewire and guiding catheter
were removed. Then a 6-French JR4 catheter was used to engage the right
coronary artery and selective right coronary artery angiography was performed.
Then, at the end of the angioplasty procedure, the guidewire and guiding
catheter were removed and diagnostic catheter removed. Arterial sheath was
sutured in place and the patient was transferred in stable condition to the
floor for further care with no complications.
RESULTS: Left main coronary artery: The left main coronary artery has no
high-grade focal stenosis. It divides into left anterior descending artery,
left circumflex artery, ramus intermedius artery.
Left circumflex artery: The left circumflex artery has an ostial 40%
stenosis.
1. Proximal left circumflex artery gives rise to small obtuse margin branch.
Just distal to the left circumflex artery has severe sequential lesions
of 60, followed by 70, followed by 80% stenosis. These are long
stenosis.
Ramus intermedius artery: Ramus intermedius artery is a medium caliber
vessel. It has a patent stent in the proximal its portion. The early portion
of the stent has a focal 40% in-stent stenosis. The rest of the vessel has
mild disease without any high-grade focal stenosis.
Left anterior descending artery: The left anterior descending artery has mild
disease in the proximal portion.
1. Just before the origin of the diagonal branch, the left anterior
descending artery has hazy 40% to 50% stenosis.
2. Left anterior descending artery gives rise to diagonal branch, which is a
small-to-medium caliber vessel with a proximal 50% stenosis, followed by
bifurcation of 2 subbranches. Both the subbranches have 50% diffuse
stenosis.
3. The mid LAD after the origin of the diagonal branch has a long stenosis
of 50% to 60% in the early portion, followed by 95% stenosis in the
midportion and another 80% stenosis in the mid distal portion.
Right coronary artery: The right coronary artery is a large dominant vessel.
Proximal right coronary artery has mild disease. Mid right coronary artery
has 40% stenosis.
1. Mid right coronary artery at the second bend has another 40% to 50%
stenosis.
2. Distal right artery has 75% stenosis, followed by focal 80% stenosis and
then bifurcates into 2 subbranches, which are PDA and posterolateral
branches.
Postprocedure after angioplasty and stent of the LAD in 2 locations including
a 2.5 x 33 mm Synergy Everolimus drug-eluting stent in the mid LAD and a 2.5 x
20 mm Synergy Everolimus drug-eluting stent in the proximal mid LAD, there is
0 residual stenosis of this lesion with no dissection, no thrombosis, distal
TIMI-3 flow. The diagonal branch is patent as before without any significant
narrowing of the ostium of the diagonal branch. There is no compromise in the
flow in the diagonal branch.
Postprocedure after angioplasty and stent of the proximal mid left circumflex
artery, there is 0% residual stenosis with no dissection, no thrombosis,
distal TIMI-3 flow.
There is a lesion in the right coronary artery in the mid distal portion,
which required angioplasty at later time.
There is a small focal narrowing of the proximal portion of the ramus
intermedius artery stent, which needs to be followed medically. These to be
treated medically.
PLAN:
1. The patient will have arterial sheath removed later today.
2. Maximal medical management of coronary artery disease and continue with
dual antiplatelet agents.
3. Consider elective angioplasty of the right coronary artery in the distal
portion with stenting.
THE PROCEDURES I CODED ARE:
92928, LD, 92928, LC. CAN I CODE FOR THE LC ANGIOGRAPHY AND RC ANGIOGRAPHY OR ARE THESE INCLUDED? - WHICH I THINK THEY ARE?
ANY HELP IS GREATLY APPRECIATED.
THANKS!
PROCEDURE PERFORMED:
1. Left heart cardiac catheterization.
2. Selective coronary artery angiography.
3. Percutaneous transluminal coronary angioplasty and stenting of the mid
left anterior descending artery with a 2.5 x 32 mm Synergy Everolimus
drug-eluting stent and percutaneous transluminal coronary angioplasty and
stenting of the proximal mid left anterior descending with a 2.5 x 20 mm
Synergy Everolimus drug-eluting stent.
4. Percutaneous transluminal coronary angioplasty and stenting of the
proximal mid left circumflex artery with a 2.5 x 38 mm Synergy Everolimus
drug-eluting stent.
INDICATIONS:
1. Coronary artery disease with a critical lesion in the mid LAD and
proximal LAD with a 95% stenosis of the mid LAD and 80% stenosis of the
proximal mid LAD.
2. Coronary artery disease with a previous history of inferolateral
myocardial infarction, angioplasty and stent of the ramus intermedius
artery, as well as previous history of significant disease of the right
coronary artery and previous history of disease in the left circumflex
artery and left anterior descending artery and diagonal branch.
3. Lateral wall ischemia and ischemic heart disease.
PROCEDURE IN DETAIL: After the informed consent was obtained, the patient was
prepped and draped in the usual sterile fashion. A 2% lidocaine was used for
local anesthesia in the right groin. Vascular access was obtained in the
right femoral artery. Over a guidewire, a 6-French long angiographic sheath
was placed in the right femoral artery.
A 6-French XB 3.5 guide without side holes was used to engage the left
coronary artery.
Left coronary artery angiography was performed.
A 0.014 Asahi Sion blue wire was used to cross the lesion in the proximal mid
LAD. A 2.5 x 30 mm balloon was used to dilate the lesion in the proximal mid
LAD at 12 atmospheres. The balloon was then removed.
Then, a 2.5 x 32 mm Synergy Everolimus drug-eluting stent was advanced in the
mid LAD and was deployed in the mid LAD at 14 atmospheres with good results.
The stent balloon was removed.
Then, a 2.5 x 20 mm Synergy Everolimus drug-eluting stent was advanced in the
proximal mid LAD and was deployed across the origin of the diagonal branch
into the mid LAD overlapping the previously placed stent and the stent was
deployed at 18 atmospheres with good results. The stent balloon was removed.
Final angiographic images were obtained. The set was then changed.
Then, a 0.014 Asahi Sion blue wire was removed and was used to cross the
lesion in the proximal mid left circumflex artery.
A 2.5 x 30 mm balloon was advanced over this and was used to dilate the lesion
in the proximal mid left circumflex artery at 8 atmospheres. The balloon was
then removed and then a 2.5 x 38 mm Synergy Everolimus drug-eluting stent was
advanced in the proximal mid left circumflex artery and was deployed at 12
atmospheres with good results. Stent balloon was removed. Final angiographic
images were obtained. The set was changed. Guidewire and guiding catheter
were removed. Then a 6-French JR4 catheter was used to engage the right
coronary artery and selective right coronary artery angiography was performed.
Then, at the end of the angioplasty procedure, the guidewire and guiding
catheter were removed and diagnostic catheter removed. Arterial sheath was
sutured in place and the patient was transferred in stable condition to the
floor for further care with no complications.
RESULTS: Left main coronary artery: The left main coronary artery has no
high-grade focal stenosis. It divides into left anterior descending artery,
left circumflex artery, ramus intermedius artery.
Left circumflex artery: The left circumflex artery has an ostial 40%
stenosis.
1. Proximal left circumflex artery gives rise to small obtuse margin branch.
Just distal to the left circumflex artery has severe sequential lesions
of 60, followed by 70, followed by 80% stenosis. These are long
stenosis.
Ramus intermedius artery: Ramus intermedius artery is a medium caliber
vessel. It has a patent stent in the proximal its portion. The early portion
of the stent has a focal 40% in-stent stenosis. The rest of the vessel has
mild disease without any high-grade focal stenosis.
Left anterior descending artery: The left anterior descending artery has mild
disease in the proximal portion.
1. Just before the origin of the diagonal branch, the left anterior
descending artery has hazy 40% to 50% stenosis.
2. Left anterior descending artery gives rise to diagonal branch, which is a
small-to-medium caliber vessel with a proximal 50% stenosis, followed by
bifurcation of 2 subbranches. Both the subbranches have 50% diffuse
stenosis.
3. The mid LAD after the origin of the diagonal branch has a long stenosis
of 50% to 60% in the early portion, followed by 95% stenosis in the
midportion and another 80% stenosis in the mid distal portion.
Right coronary artery: The right coronary artery is a large dominant vessel.
Proximal right coronary artery has mild disease. Mid right coronary artery
has 40% stenosis.
1. Mid right coronary artery at the second bend has another 40% to 50%
stenosis.
2. Distal right artery has 75% stenosis, followed by focal 80% stenosis and
then bifurcates into 2 subbranches, which are PDA and posterolateral
branches.
Postprocedure after angioplasty and stent of the LAD in 2 locations including
a 2.5 x 33 mm Synergy Everolimus drug-eluting stent in the mid LAD and a 2.5 x
20 mm Synergy Everolimus drug-eluting stent in the proximal mid LAD, there is
0 residual stenosis of this lesion with no dissection, no thrombosis, distal
TIMI-3 flow. The diagonal branch is patent as before without any significant
narrowing of the ostium of the diagonal branch. There is no compromise in the
flow in the diagonal branch.
Postprocedure after angioplasty and stent of the proximal mid left circumflex
artery, there is 0% residual stenosis with no dissection, no thrombosis,
distal TIMI-3 flow.
There is a lesion in the right coronary artery in the mid distal portion,
which required angioplasty at later time.
There is a small focal narrowing of the proximal portion of the ramus
intermedius artery stent, which needs to be followed medically. These to be
treated medically.
PLAN:
1. The patient will have arterial sheath removed later today.
2. Maximal medical management of coronary artery disease and continue with
dual antiplatelet agents.
3. Consider elective angioplasty of the right coronary artery in the distal
portion with stenting.
THE PROCEDURES I CODED ARE:
92928, LD, 92928, LC. CAN I CODE FOR THE LC ANGIOGRAPHY AND RC ANGIOGRAPHY OR ARE THESE INCLUDED? - WHICH I THINK THEY ARE?
ANY HELP IS GREATLY APPRECIATED.
THANKS!
