bevann0402@bellsouth.net
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wanting to double check because I have not had a report like this yet. My work is finally letting me go to a seminar to help me out on cardiology, but it is next month--.
1st thing to know on this report, this patient had a Left heart cath (cpt 93458) the day before this procedure-the findings of that procedure lead to this procedure-the main reason this all was not done at same time(if it could be done together??) was he had to be moved to a different facility for the below.
Procedure Performed:
1. 6 French sheath placed in the left common femoral artery w/o difficulty
2. coronary angiography in the right coronary artery
3. percutaneous coronary intervention, DES to the distal right coronary artery
4. attempted but Unsuccessful stenting of the posterior descending artery
5. plan on balloon angioplasty to the posterior descending artery
description
the details of PCI to RCA and coronary angiography were explained. pt underwent 6-french sheath placement to common femoral w/o difficulty. coronary angiography was then performed. It revealed 30% to 50% stenosis from the ostial down to the mid RCA. there was 30% at the bend, and then the distal RCA with a 70% lesion in the posterior descending artery having an 80% mid lesion.
The lesion was wired in its entirety utilizing a Prowater wire after Angiomax was started. we used a JR 4.0 guide. we then ballooned utilizing a 2.5x12 mm sprinter at 14 for 30 and 14 for 30. we then attempted to place a stent into the posterior descending artery, and this was unsuccessful. we ran into quite a bit of difficulty. we ended up butting it with a Prowater and a Grand Slam, unsuccessful. we attempted to place a Grand Slam and a buddy Grand Slam, also unsuccessful. we did attempt to change out the guide to implants, and we aslo tried a JR 3.5 and an Alright guide, all unable to seat well. Ultimately, we changed out a brand new JR 4.0 and continued the attempt to place a stent across the predilated posterior descending artery lesion. the lesion was 80% it was reduced to about 40% to 50%. we were able to stent the distal RCA utilizing 2.5 x24 mm stent, this was deployed at 12 atmospheres for 30 seconds and was posted with a 2.5x20 noncompliant balloon at 12 for 30 and 14 for 30. after multiple attempts, increasing fluoro time and increasing dye load, we had to stop our attempts to place a stent in the posterior descending artery. angiography was performed with and without wire in place. there was not change to the posterior descending artery, it has continued TIMI-3 flow distally. the lesion is not quite as tight as it was predilatation, and we did see a heavy large blush. the stented area appears to be well deployed against the distal RCA lesion.
the patient left lab with recommendations for consideration for a second attempt to try to stent the posterior descending artery at a later date after dye has flushed from his system.
Since he was successful in the stent placement in the RCA, am I correct in that the code will be: 92928-RC
for the attempt on the Posterior descending artery, do I get to code that and use the 53 modifier? If so, I am unsure which code?
Thanks so much
Beverly
1st thing to know on this report, this patient had a Left heart cath (cpt 93458) the day before this procedure-the findings of that procedure lead to this procedure-the main reason this all was not done at same time(if it could be done together??) was he had to be moved to a different facility for the below.
Procedure Performed:
1. 6 French sheath placed in the left common femoral artery w/o difficulty
2. coronary angiography in the right coronary artery
3. percutaneous coronary intervention, DES to the distal right coronary artery
4. attempted but Unsuccessful stenting of the posterior descending artery
5. plan on balloon angioplasty to the posterior descending artery
description
the details of PCI to RCA and coronary angiography were explained. pt underwent 6-french sheath placement to common femoral w/o difficulty. coronary angiography was then performed. It revealed 30% to 50% stenosis from the ostial down to the mid RCA. there was 30% at the bend, and then the distal RCA with a 70% lesion in the posterior descending artery having an 80% mid lesion.
The lesion was wired in its entirety utilizing a Prowater wire after Angiomax was started. we used a JR 4.0 guide. we then ballooned utilizing a 2.5x12 mm sprinter at 14 for 30 and 14 for 30. we then attempted to place a stent into the posterior descending artery, and this was unsuccessful. we ran into quite a bit of difficulty. we ended up butting it with a Prowater and a Grand Slam, unsuccessful. we attempted to place a Grand Slam and a buddy Grand Slam, also unsuccessful. we did attempt to change out the guide to implants, and we aslo tried a JR 3.5 and an Alright guide, all unable to seat well. Ultimately, we changed out a brand new JR 4.0 and continued the attempt to place a stent across the predilated posterior descending artery lesion. the lesion was 80% it was reduced to about 40% to 50%. we were able to stent the distal RCA utilizing 2.5 x24 mm stent, this was deployed at 12 atmospheres for 30 seconds and was posted with a 2.5x20 noncompliant balloon at 12 for 30 and 14 for 30. after multiple attempts, increasing fluoro time and increasing dye load, we had to stop our attempts to place a stent in the posterior descending artery. angiography was performed with and without wire in place. there was not change to the posterior descending artery, it has continued TIMI-3 flow distally. the lesion is not quite as tight as it was predilatation, and we did see a heavy large blush. the stented area appears to be well deployed against the distal RCA lesion.
the patient left lab with recommendations for consideration for a second attempt to try to stent the posterior descending artery at a later date after dye has flushed from his system.
Since he was successful in the stent placement in the RCA, am I correct in that the code will be: 92928-RC
for the attempt on the Posterior descending artery, do I get to code that and use the 53 modifier? If so, I am unsure which code?
Thanks so much
Beverly