carelitz
Guest
Can you guys check my work please? I am really new at this! Thanks!
Here are the codes I pulled out from the report:
93458 26 XU for the LHC
92941 LD for the STENT in LD during MI
93571 26 LD for the FFR of LD
99152 This shows in the hospital report
99222 25 This is a separate document
Thanks for any feedback!
PROCEDURE PERFORMED:
1. Left heart catheterization.
2. Coronary angiography.
3. Left ventriculogram subsequent fractional flow reserve of the left anterior descending and stent and percutaneous transluminal coronary angioplasty of the left anterior descending artery.
INDICATIONS FOR PROCEDURE: This is a patient with a non-ST elevation myocardial infarction. The patient had undergone an atrial fibrillation ablation yesterday, developed some episodes of nausea and emesis overnight. Troponins have been drawn and is elevated at 6. He was therefore referred for an invasive risk stratification for this non-ST elevation myocardial infarction.
DESCRIPTION OF PROCEDURE: Informed consent was obtained. The patient was brought to the cath lab in a fasting condition. He was sterilely prepped and draped in the usual fashion and the right femoral artery entered using the modified Seldinger technique. Following this, left heart catheterization was done with a 6-French JL4 and JR4 catheter with multiple coronary angiograms to be done in multiple projections. Following this, a 6-French pigtail was inserted across the aortic valve and into the left ventricle. Hemodynamic data was gathered. LV gram was done in the RAO projection. The catheter was pulled back across the aortic valve where no gradient was seen. At this point review of the angiograms reveals a moderate appearing stenosis in the LAD just after the first diagonal branch. This was felt potentially hemodynamically significant, but not for certain. Therefore FFR was pursued.
The patient did receive Angiomax bolus and infusion, after which the St. Jude FFR wire was advanced to the end of the guide. The pressure was equalized and the wire was then advanced into the distal LAD. Following an infusion of adenosine, a maximum FFR of 0.77 was documented. This is consistent with a hemodynamically significant lesion. Therefore a stenting was done. A 2.5 x 23 Xience was selected. It was deployed at 12 atmospheres x20 seconds. It is under expanded in mid portion; therefore, a 2.75 x 20 NC Trek balloon was used and it was deployed at 20 atmospheres times 35 seconds. This resulted in excellent angiographic result. We did re-measure a FFR postprocedure of 0.93. That was without adenosine. The FFR ____ lesion without adenosine was 0.86. At this point, all catheters and wires were then removed. The arterial sheath was sutured into place with plans to remove it later with manual compression for hemostasis. The intraprocedural medicines include sedatives per nursing flow sheets, Angiomax bolus and infusion, ticagrelor 180 mg load. The patient has a history of ASPIRIN ALLERGY manifested by "acute respiratory distress," therefore, this was not administered. His conscious sedation time was 36 minutes. Contrast and flow amounts are elucidated in the cath lab report.
STUDY FINDINGS: HEMODYNAMICS: The central aortic pressure was 117/64 with a mean of 90 and LV pressure 121/15 with pulse A wave of 20. There was no gradient across the aortic valve.
ANGIOGRAPHIC FINDINGS: Left main is a moderate size vessel, fairly short length, but otherwise angiographically normal. The left circumflex is moderate in size. There is some mild fluoroscopic calcification seen proximally and some mild plaquing in the order of 10 to 20 percent and the proximal vessel gives rise to a moderate-to-large-sized first obtuse marginal branch which had some 25 percent plaquing in the proximal vessel but no high-grade lesions. The LAD is moderate in size. It has some 10 to 20 percent plaquing proximally as well as some mild fluoroscopic calcification. There is moderate fluoroscopic calcification in the mid vessel and in that area there is a stenosis which angiographically appears to be in the range of about 60 to 70 percent just after the first diagonal branch. The ongoing vessel was free of any significant disease. It does reach _____ apex. The first diagonal branch has a 25 percent ostial narrowing. The right coronary artery is a moderate-sized vessel, it is dominant. There is a fairly long area of eccentric plaque in the proximal into the mid vessel that is in the range of approximately 30 percent stenosis. The ongoing vessel gives rise to a moderate-sized posterior descending without significant disease. There is no significant posterolateral branches emerging from the system. The left ventriculogram in the RAO projection demonstrates no wall motion abnormalities and ejection fraction of approximately 55 percent. The interventional result of the area of 60 to 70 percent stenosis in the mid LAD is reduced to 0 percent residual. There is TIMI 3 flow present pre-and post-procedure. Another impression is that of a positive FFR with a maximum FFR of 0.77 that was done pre-intervention.
Here are the codes I pulled out from the report:
93458 26 XU for the LHC
92941 LD for the STENT in LD during MI
93571 26 LD for the FFR of LD
99152 This shows in the hospital report
99222 25 This is a separate document
Thanks for any feedback!
PROCEDURE PERFORMED:
1. Left heart catheterization.
2. Coronary angiography.
3. Left ventriculogram subsequent fractional flow reserve of the left anterior descending and stent and percutaneous transluminal coronary angioplasty of the left anterior descending artery.
INDICATIONS FOR PROCEDURE: This is a patient with a non-ST elevation myocardial infarction. The patient had undergone an atrial fibrillation ablation yesterday, developed some episodes of nausea and emesis overnight. Troponins have been drawn and is elevated at 6. He was therefore referred for an invasive risk stratification for this non-ST elevation myocardial infarction.
DESCRIPTION OF PROCEDURE: Informed consent was obtained. The patient was brought to the cath lab in a fasting condition. He was sterilely prepped and draped in the usual fashion and the right femoral artery entered using the modified Seldinger technique. Following this, left heart catheterization was done with a 6-French JL4 and JR4 catheter with multiple coronary angiograms to be done in multiple projections. Following this, a 6-French pigtail was inserted across the aortic valve and into the left ventricle. Hemodynamic data was gathered. LV gram was done in the RAO projection. The catheter was pulled back across the aortic valve where no gradient was seen. At this point review of the angiograms reveals a moderate appearing stenosis in the LAD just after the first diagonal branch. This was felt potentially hemodynamically significant, but not for certain. Therefore FFR was pursued.
The patient did receive Angiomax bolus and infusion, after which the St. Jude FFR wire was advanced to the end of the guide. The pressure was equalized and the wire was then advanced into the distal LAD. Following an infusion of adenosine, a maximum FFR of 0.77 was documented. This is consistent with a hemodynamically significant lesion. Therefore a stenting was done. A 2.5 x 23 Xience was selected. It was deployed at 12 atmospheres x20 seconds. It is under expanded in mid portion; therefore, a 2.75 x 20 NC Trek balloon was used and it was deployed at 20 atmospheres times 35 seconds. This resulted in excellent angiographic result. We did re-measure a FFR postprocedure of 0.93. That was without adenosine. The FFR ____ lesion without adenosine was 0.86. At this point, all catheters and wires were then removed. The arterial sheath was sutured into place with plans to remove it later with manual compression for hemostasis. The intraprocedural medicines include sedatives per nursing flow sheets, Angiomax bolus and infusion, ticagrelor 180 mg load. The patient has a history of ASPIRIN ALLERGY manifested by "acute respiratory distress," therefore, this was not administered. His conscious sedation time was 36 minutes. Contrast and flow amounts are elucidated in the cath lab report.
STUDY FINDINGS: HEMODYNAMICS: The central aortic pressure was 117/64 with a mean of 90 and LV pressure 121/15 with pulse A wave of 20. There was no gradient across the aortic valve.
ANGIOGRAPHIC FINDINGS: Left main is a moderate size vessel, fairly short length, but otherwise angiographically normal. The left circumflex is moderate in size. There is some mild fluoroscopic calcification seen proximally and some mild plaquing in the order of 10 to 20 percent and the proximal vessel gives rise to a moderate-to-large-sized first obtuse marginal branch which had some 25 percent plaquing in the proximal vessel but no high-grade lesions. The LAD is moderate in size. It has some 10 to 20 percent plaquing proximally as well as some mild fluoroscopic calcification. There is moderate fluoroscopic calcification in the mid vessel and in that area there is a stenosis which angiographically appears to be in the range of about 60 to 70 percent just after the first diagonal branch. The ongoing vessel was free of any significant disease. It does reach _____ apex. The first diagonal branch has a 25 percent ostial narrowing. The right coronary artery is a moderate-sized vessel, it is dominant. There is a fairly long area of eccentric plaque in the proximal into the mid vessel that is in the range of approximately 30 percent stenosis. The ongoing vessel gives rise to a moderate-sized posterior descending without significant disease. There is no significant posterolateral branches emerging from the system. The left ventriculogram in the RAO projection demonstrates no wall motion abnormalities and ejection fraction of approximately 55 percent. The interventional result of the area of 60 to 70 percent stenosis in the mid LAD is reduced to 0 percent residual. There is TIMI 3 flow present pre-and post-procedure. Another impression is that of a positive FFR with a maximum FFR of 0.77 that was done pre-intervention.
