CardioCoder79
Networker
My initial thought was to use 93567 but that's specific to the ascending aorta/aortic root. This states that he's looking at the renals non-selectively via the descending aorta. I'm thinking 75625 but of course CCI edits point me to use a modifier. Thoughts?
HISTORY: A 61-year-old referred for cardiac catheterization and renal angiography. History of hypertension, uncontrolled, and coronary disease with stents in the left main as well as LAD. By history, she has a nonfunctioning LIMA to LAD and a nonfunctioning saphenous vein graft.
DESCRIPTION: Informed written consent was obtained. The patient was brought to the cardiac catheterization laboratory where the right groin was prepped in sterile fashion and anesthetized with local 1% Xylocaine. Using a
modified Seldinger technique, a 5-French introducer sheath was placed in the
right femoral artery. The following catheters were used: A 5-French Judkins
left 4, a 5-French Judkins right 4, a 5-French straight pigtail. A 5-French
LIMA catheter was used for the renal arteriography. Left ventriculography
was performed in the standard projection and nonselective descending
aortogram was also performed. Patient received Versed and fentanyl during
the procedure. After the procedure, hemostasis obtained with direct
pressure.
HEMODYNAMIC DATA: Aortic pressure 122/74. LV pressure is 123/0. End-
diastolic pressure was 16 mmHg. There is no gradient on pullback across the
aortic valve.
CORONARY ANATOMY: The left main coronary originates from the left coronary cusp. There is a previous deployed stent in the left main coronary artery which is a fairly short length stent of large caliber. It is widely patent.
I do not see any evidence of in-stent restenosis.
Left anterior descending artery. This is a large caliber vessel, fairly
smooth throughout its course. There is a large stent deployed in the
proximal segment. This could be one stent or overlapping stents. It is
widely patent without evidence of in-stent restenosis. There are some very
small jailed diagonal arteries within this area. They appear 1 mm or less in
diameter and are not considered significant. The rest of the LAD has only
nonsignificant disease.
Left circumflex artery. This is essentially a large obtuse marginal artery
branch which has minor disease but no obstructive lesions.
Right coronary artery. This is a dominant vessel originating from the right
coronary cusp which appears normal throughout its course.
LEFT VENTRICULOGRAPHY: This was performed in standard projection. Ejection fraction is estimated at 65%. No wall motion abnormalities. Her left
ventricle and her heart is generally very vertical in orientation.
RENAL ANGIOGRAM: A nonselective descending aortogram was performed. It
demonstrates what appears to be no significant aneurysm. There is evidence
of a displaced right kidney with long renal artery present. This appears to
be a pelvic type renal kidney. The left renal artery has mild disease but no
obstructive lesions. The right renal artery is a long artery which has
approximately a 40% lesion near its ostium but no obstructive lesions
distally, coursing into the kidney with a somewhat inferior placement.
CONCLUSIONS:
1. Mild coronary disease with:
a.Patent stent in left main.
b. Patent stent in the left anterior descending artery.
c. Minor disease elsewhere.
2. Preserved left ventricular systolic performance.
3. Forty percent renal artery stenosis of the right renal artery with a
somewhat displaced inferiorly right kidney.
HISTORY: A 61-year-old referred for cardiac catheterization and renal angiography. History of hypertension, uncontrolled, and coronary disease with stents in the left main as well as LAD. By history, she has a nonfunctioning LIMA to LAD and a nonfunctioning saphenous vein graft.
DESCRIPTION: Informed written consent was obtained. The patient was brought to the cardiac catheterization laboratory where the right groin was prepped in sterile fashion and anesthetized with local 1% Xylocaine. Using a
modified Seldinger technique, a 5-French introducer sheath was placed in the
right femoral artery. The following catheters were used: A 5-French Judkins
left 4, a 5-French Judkins right 4, a 5-French straight pigtail. A 5-French
LIMA catheter was used for the renal arteriography. Left ventriculography
was performed in the standard projection and nonselective descending
aortogram was also performed. Patient received Versed and fentanyl during
the procedure. After the procedure, hemostasis obtained with direct
pressure.
HEMODYNAMIC DATA: Aortic pressure 122/74. LV pressure is 123/0. End-
diastolic pressure was 16 mmHg. There is no gradient on pullback across the
aortic valve.
CORONARY ANATOMY: The left main coronary originates from the left coronary cusp. There is a previous deployed stent in the left main coronary artery which is a fairly short length stent of large caliber. It is widely patent.
I do not see any evidence of in-stent restenosis.
Left anterior descending artery. This is a large caliber vessel, fairly
smooth throughout its course. There is a large stent deployed in the
proximal segment. This could be one stent or overlapping stents. It is
widely patent without evidence of in-stent restenosis. There are some very
small jailed diagonal arteries within this area. They appear 1 mm or less in
diameter and are not considered significant. The rest of the LAD has only
nonsignificant disease.
Left circumflex artery. This is essentially a large obtuse marginal artery
branch which has minor disease but no obstructive lesions.
Right coronary artery. This is a dominant vessel originating from the right
coronary cusp which appears normal throughout its course.
LEFT VENTRICULOGRAPHY: This was performed in standard projection. Ejection fraction is estimated at 65%. No wall motion abnormalities. Her left
ventricle and her heart is generally very vertical in orientation.
RENAL ANGIOGRAM: A nonselective descending aortogram was performed. It
demonstrates what appears to be no significant aneurysm. There is evidence
of a displaced right kidney with long renal artery present. This appears to
be a pelvic type renal kidney. The left renal artery has mild disease but no
obstructive lesions. The right renal artery is a long artery which has
approximately a 40% lesion near its ostium but no obstructive lesions
distally, coursing into the kidney with a somewhat inferior placement.
CONCLUSIONS:
1. Mild coronary disease with:
a.Patent stent in left main.
b. Patent stent in the left anterior descending artery.
c. Minor disease elsewhere.
2. Preserved left ventricular systolic performance.
3. Forty percent renal artery stenosis of the right renal artery with a
somewhat displaced inferiorly right kidney.
