Physician reports he did LHC,SCA,LIMA/RIMA,SUBCLAVIAN ARTERIOGRAM,PCI DIAG 1 and DIAG 2
OP REPORT
1- Selective coronary angiogram of the left main (LM) and right coronary artery (RCA).
2- A left heart catheterization without ventriculogram was performed.
3- Selective angiogram of SVG-RCA and LIMA-LAD
4- Percutaneous coronary intervention of D1 with a 2.25 x 16mm Promus Premier
5- Percutaneous coronary intervention of D2 with a 2.25 x 16mm Promus Premier
4- Right CFA angiogram
5- Right CFA Angioseal
Procedure (Diagnostic):
The procedure was described to the patient including benefits, risks, and alternatives to the procedure. The patient confirmed understanding. The patient signed the informed consent. She was brought into the cath lab. The bilateral groins were prepped in a sterile fashion, and a sterile drape was placed over the patient.
The right common femoral artery (CFA) was palpated and the region above the artery was anesthetized with 2% local lidocaine. Using a 4 Fr Cook needle, with the modified Seldinger technique, vascular access was obtained to the right CFA whereby a 6 French sheath was placed without difficulty.
A 6 Fr diagnostic JL4 catheter was advanced over a J-tipped wire to the ascending aorta. The J wire was removed, the catheter aspirated to ensure no air was in the system and flushed in the usual fashion. The diagnostic catheter engaged the left main coronary artery without difficulty. Pictures of the left coronary system were taken in several various orthogonal angles.
The diagnostic catheter used for the left coronary was subsequently removed over the J wire and a 6 Fr diagnostic JR4 catheter was advanced over a J-tipped wire to the ascending aorta.The J wire was removed, the catheter aspirated to ensure no air was in the system and flushed in the usual fashion. The diagnostic catheter engaged the right coronary artery without difficulty. Pictures of the right coronary system were taken in several various orthogonal angles. The catheter was used to engage the SVG-IM and LIMA-LAD, and angiographic views were obtained. The diagnostic RCA catheter was removed from the descending aorta over a J wire.
A 5 Fr MP catheter was used to engage the SVG-RCA and angiographic views were obtained. A left heart catheterization without ventriculogram was performed. A 5 Fr MP catheter was placed over the wire and guided into the left ventricle. The J wire was removed, the catheter aspirated to ensure no air was in the system and flushed in the usual fashion. Left ventricular pressures were 153 with an LVEDP of 20. The catheter was then pulled back across the aortic valve and there was not a significant gradient across the valve. The pigtail catheter was then removed from the descending aorta over a J wire.
Coronary Angiography Findings:
Left Main
Patent with no significant obstructive CAD
Left Anterior Descending
Diffusely diseased, D1 and D2 with 90% stenoses, competitive flow seen in distal LAD
Left Circumflex
Occluded at the ostium
Right Coronary
Mid RCA occluded
PDA
Mild non-occlusive plaques
LIMA to LAD
Patent
SVG to RCA
Patent
After reviewing the images, coronary intervention was deemed necessary.
Procedure (Intervention):
The 5 Fr. sheath was exchanged out for a 7 Fr. sheath.
Anticoagulation with bivalirudin was initiated. An ACT was performed to ensure administration of the Bivalirdin..
A 6 Fr XB 3.0 guiding catheter was advanced over a J-tipped wire to the ascending aorta. The J-tipped wire was removed and the catheter was aspirated to ensure no air was in the system. The catheter was then flushed in the usual manner. The guiding catheter was then seated into the left main ostium.
A 0.014" Asahi Prowater wire was inserted into the guiding catheter and advanced into the D1 coronary artery and passed through the target lesion. Angiography revealed no significant trauma or complication from wire crossing. A 2.0 x 12 mm Emerge balloon was advanced over the wire to the target lesion and was inflated. The balloon was removed. An Asahi Sion Blue was advanced into D2, and D2 was ballooned using a 2.0 x 12mm Emerge.
Next, we advanced a 2.25 x 16 mm Promus Premier stent over the wire to the D2 target lesion and deployed. The stent balloon was removed. A second 2.25 x 16mm Promus Premier was used to stent D1.
Final angiography revealed adequate stent expansion with no evidence of dissection or distal embolization. There was TIMI III flow distally.
At this point the intervention was deemed successful and the procedure completed. The wire and balloon were removed from the coronary artery. The guiding catheter was disengaged from the coronary artery and removed from the body over the J tipped wire.
Closure:
Angiography of the CFA was performed without evidence of dissection, thrombus or perforation. Therefore the access was deemed acceptable for a closure device. A 8 Fr Angioseal was subsequently deployed without complication. The patient was sent to the holding area in stable condition. The patient was hemodynamically stable throughout the entirety of the procedure.
Stent Implanted:
Location of Stent
2.25 x 16 mm Promus Premier
D1
2.25 x 16 mm Promus Premier
D2
Medicare patient, would this be billed as 93459 (26)(59), 92928 (LD),92928(LD)(59) or
93459 (26)(59),92928 (LD),92929 (LD)(59)
I did some research and have read that mcr does not pay for add on code 92929 any info on this?
OP REPORT
1- Selective coronary angiogram of the left main (LM) and right coronary artery (RCA).
2- A left heart catheterization without ventriculogram was performed.
3- Selective angiogram of SVG-RCA and LIMA-LAD
4- Percutaneous coronary intervention of D1 with a 2.25 x 16mm Promus Premier
5- Percutaneous coronary intervention of D2 with a 2.25 x 16mm Promus Premier
4- Right CFA angiogram
5- Right CFA Angioseal
Procedure (Diagnostic):
The procedure was described to the patient including benefits, risks, and alternatives to the procedure. The patient confirmed understanding. The patient signed the informed consent. She was brought into the cath lab. The bilateral groins were prepped in a sterile fashion, and a sterile drape was placed over the patient.
The right common femoral artery (CFA) was palpated and the region above the artery was anesthetized with 2% local lidocaine. Using a 4 Fr Cook needle, with the modified Seldinger technique, vascular access was obtained to the right CFA whereby a 6 French sheath was placed without difficulty.
A 6 Fr diagnostic JL4 catheter was advanced over a J-tipped wire to the ascending aorta. The J wire was removed, the catheter aspirated to ensure no air was in the system and flushed in the usual fashion. The diagnostic catheter engaged the left main coronary artery without difficulty. Pictures of the left coronary system were taken in several various orthogonal angles.
The diagnostic catheter used for the left coronary was subsequently removed over the J wire and a 6 Fr diagnostic JR4 catheter was advanced over a J-tipped wire to the ascending aorta.The J wire was removed, the catheter aspirated to ensure no air was in the system and flushed in the usual fashion. The diagnostic catheter engaged the right coronary artery without difficulty. Pictures of the right coronary system were taken in several various orthogonal angles. The catheter was used to engage the SVG-IM and LIMA-LAD, and angiographic views were obtained. The diagnostic RCA catheter was removed from the descending aorta over a J wire.
A 5 Fr MP catheter was used to engage the SVG-RCA and angiographic views were obtained. A left heart catheterization without ventriculogram was performed. A 5 Fr MP catheter was placed over the wire and guided into the left ventricle. The J wire was removed, the catheter aspirated to ensure no air was in the system and flushed in the usual fashion. Left ventricular pressures were 153 with an LVEDP of 20. The catheter was then pulled back across the aortic valve and there was not a significant gradient across the valve. The pigtail catheter was then removed from the descending aorta over a J wire.
Coronary Angiography Findings:
Left Main
Patent with no significant obstructive CAD
Left Anterior Descending
Diffusely diseased, D1 and D2 with 90% stenoses, competitive flow seen in distal LAD
Left Circumflex
Occluded at the ostium
Right Coronary
Mid RCA occluded
PDA
Mild non-occlusive plaques
LIMA to LAD
Patent
SVG to RCA
Patent
After reviewing the images, coronary intervention was deemed necessary.
Procedure (Intervention):
The 5 Fr. sheath was exchanged out for a 7 Fr. sheath.
Anticoagulation with bivalirudin was initiated. An ACT was performed to ensure administration of the Bivalirdin..
A 6 Fr XB 3.0 guiding catheter was advanced over a J-tipped wire to the ascending aorta. The J-tipped wire was removed and the catheter was aspirated to ensure no air was in the system. The catheter was then flushed in the usual manner. The guiding catheter was then seated into the left main ostium.
A 0.014" Asahi Prowater wire was inserted into the guiding catheter and advanced into the D1 coronary artery and passed through the target lesion. Angiography revealed no significant trauma or complication from wire crossing. A 2.0 x 12 mm Emerge balloon was advanced over the wire to the target lesion and was inflated. The balloon was removed. An Asahi Sion Blue was advanced into D2, and D2 was ballooned using a 2.0 x 12mm Emerge.
Next, we advanced a 2.25 x 16 mm Promus Premier stent over the wire to the D2 target lesion and deployed. The stent balloon was removed. A second 2.25 x 16mm Promus Premier was used to stent D1.
Final angiography revealed adequate stent expansion with no evidence of dissection or distal embolization. There was TIMI III flow distally.
At this point the intervention was deemed successful and the procedure completed. The wire and balloon were removed from the coronary artery. The guiding catheter was disengaged from the coronary artery and removed from the body over the J tipped wire.
Closure:
Angiography of the CFA was performed without evidence of dissection, thrombus or perforation. Therefore the access was deemed acceptable for a closure device. A 8 Fr Angioseal was subsequently deployed without complication. The patient was sent to the holding area in stable condition. The patient was hemodynamically stable throughout the entirety of the procedure.
Stent Implanted:
Location of Stent
2.25 x 16 mm Promus Premier
D1
2.25 x 16 mm Promus Premier
D2
Medicare patient, would this be billed as 93459 (26)(59), 92928 (LD),92928(LD)(59) or
93459 (26)(59),92928 (LD),92929 (LD)(59)
I did some research and have read that mcr does not pay for add on code 92929 any info on this?