The doctor wants me to use 93460-26 for this procedure, but he wasn't able to keep the catheter in there long enough to do the pressure or LVG. Is there any way to give him any credit for the work he did to get the catheter through the aortic valve? I just used 93456-26. Thank you in advance for your help. Here is the report.
DESCRIPTION OF PROCEDURE: After informed consent was obtained, patient's left femoral region was prepped, draped and infiltrated with Xylocaine. A 7-French sheath was placed in the left femoral vein and a 6-French sheath in left femoral artery via the modified Seldinger technique. A Swan-Ganz catheter was advanced to the right ventricle. Multiple attempts at getting it to advance into the pulmonary artery were unsuccessful despite use of a 0.025 guidewire, and multiple manipulations. Right atrial and right ventricular pressure was recorded. This catheter was removed. A 6-French pigtail catheter was advanced to the ascending aorta. There was some difficulty crossing the abdominal aorta and all further catheter exchanges were made over guidewire.
Attempts at advancing the pigtail catheter could not be prolapsed across the
aortic valve. Attempts at passing a straight guidewire through the pigtail
catheter across the stenotic aortic valve were unsuccessful. Attempts were
also unsuccessful with Judkins 4 right catheter. A 6-French AL1 catheter was
used to successfully advance a straight guidewire across the aortic valve.
Because of severe aortic tortuosity, this catheter was not long enough to
advance into the left ventricle. It was exchanged over the long guidewire for a 5-French multipurpose catheter. This was advanced across the aortic valve into the left ventricle. With removal of the wire; however, the catheter was not long enough to stay seated in the left ventricle and prolapsed back across the aortic valve into the aorta. This catheter was removed.
The 6-French Judkins 4 right catheter was used for right coronary angiography.
A 6-French Judkins 6 left catheter was used for left coronary angiography.
The arterial sheath was removed and hemostasis was achieved using StarClose closure device. The venous sheath was removed and hemostasis was achieved using direct pressure over the vein with a Neptune pad.
Patient tolerated the procedure well without complications. He was
transferred to his room in good condition.
DESCRIPTION OF PROCEDURE: After informed consent was obtained, patient's left femoral region was prepped, draped and infiltrated with Xylocaine. A 7-French sheath was placed in the left femoral vein and a 6-French sheath in left femoral artery via the modified Seldinger technique. A Swan-Ganz catheter was advanced to the right ventricle. Multiple attempts at getting it to advance into the pulmonary artery were unsuccessful despite use of a 0.025 guidewire, and multiple manipulations. Right atrial and right ventricular pressure was recorded. This catheter was removed. A 6-French pigtail catheter was advanced to the ascending aorta. There was some difficulty crossing the abdominal aorta and all further catheter exchanges were made over guidewire.
Attempts at advancing the pigtail catheter could not be prolapsed across the
aortic valve. Attempts at passing a straight guidewire through the pigtail
catheter across the stenotic aortic valve were unsuccessful. Attempts were
also unsuccessful with Judkins 4 right catheter. A 6-French AL1 catheter was
used to successfully advance a straight guidewire across the aortic valve.
Because of severe aortic tortuosity, this catheter was not long enough to
advance into the left ventricle. It was exchanged over the long guidewire for a 5-French multipurpose catheter. This was advanced across the aortic valve into the left ventricle. With removal of the wire; however, the catheter was not long enough to stay seated in the left ventricle and prolapsed back across the aortic valve into the aorta. This catheter was removed.
The 6-French Judkins 4 right catheter was used for right coronary angiography.
A 6-French Judkins 6 left catheter was used for left coronary angiography.
The arterial sheath was removed and hemostasis was achieved using StarClose closure device. The venous sheath was removed and hemostasis was achieved using direct pressure over the vein with a Neptune pad.
Patient tolerated the procedure well without complications. He was
transferred to his room in good condition.