amym
Guest
Is it appropriate to bill 93460-26 and 93567 for the following case?
SUMMARY:
-- CORONARY CIRCULATION:
-- There was 1-vessel coronary artery disease ( 30 % LAD).
-- HEMODYNAMICS:
-- Hemodynamic assessment demonstrates mild systemic hypertension.
PROCEDURES PERFORMED:
-- Right heart catheterization.
-- Left heart catheterization.
-- Left coronary angiography.
-- Right coronary angiography.
-- Ascending aortography.
RECOMMENDATIONS:
The patient should continue with the present medications.
INDICATIONS: Cardiac: aortic valve disease.
HEMODYNAMICS: Not done as Aortic valve was not crossed Hemodynamic
assessment demonstrates mild systemic hypertension.
VENTRICLES: Aortic valve could not be crossed due to severe stenosis and
angulation.
CORONARY VESSELS: The coronary circulation is right dominant. There was
1-vessel coronary artery disease ( 30 % LAD). There was no angiographic
evidence for occlusive coronary artery disease. Left main: Normal. Mid
LAD: There was a 30 % stenosis. Circumflex: Normal. RCA: 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.
-- Right femoral vein 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.
-- Right heart catheterization. A catheter was advanced to the pulmonary
artery wedge position under fluoroscopic guidance. Measurements of
pressures and arterial and venous oxygen saturation were obtained. The
catheter remained in place throughout the procedure for continuous
monitoring of pulmonary artery pressure.
-- 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.
-- Right 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.
-- Ascending aortography. A catheter was placed and contrast was
injected.
SUMMARY:
-- CORONARY CIRCULATION:
-- There was 1-vessel coronary artery disease ( 30 % LAD).
-- HEMODYNAMICS:
-- Hemodynamic assessment demonstrates mild systemic hypertension.
PROCEDURES PERFORMED:
-- Right heart catheterization.
-- Left heart catheterization.
-- Left coronary angiography.
-- Right coronary angiography.
-- Ascending aortography.
RECOMMENDATIONS:
The patient should continue with the present medications.
INDICATIONS: Cardiac: aortic valve disease.
HEMODYNAMICS: Not done as Aortic valve was not crossed Hemodynamic
assessment demonstrates mild systemic hypertension.
VENTRICLES: Aortic valve could not be crossed due to severe stenosis and
angulation.
CORONARY VESSELS: The coronary circulation is right dominant. There was
1-vessel coronary artery disease ( 30 % LAD). There was no angiographic
evidence for occlusive coronary artery disease. Left main: Normal. Mid
LAD: There was a 30 % stenosis. Circumflex: Normal. RCA: 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.
-- Right femoral vein 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.
-- Right heart catheterization. A catheter was advanced to the pulmonary
artery wedge position under fluoroscopic guidance. Measurements of
pressures and arterial and venous oxygen saturation were obtained. The
catheter remained in place throughout the procedure for continuous
monitoring of pulmonary artery pressure.
-- 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.
-- Right 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.
-- Ascending aortography. A catheter was placed and contrast was
injected.
