bhargavi
Guru
Hemodynamics:
The left ventricular pressure was 5 mmHg. The aortic pressure was 137/65 mmHg.
Coronary Angiography:
Right coronary artery is 100% occluded at the ostium. Distal vessel is filling via left-to-right collaterals.
Left Main is angiographically normal.
Left anterior descending is a medium to large caliber vessel with ostial 60 to 70% stenosis, mild to moderate diffuse mid vessel disease, patent distal segment. This is a type III wraparound LAD. LAD is providing collaterals to distal RCA.
Diagonal 1 is a small to medium caliber vessel with ostial 50% stenosis, patent mid to distal segment. Diagonal 2 is a small caliber vessel appears angiographically normal.
Left circumflex is 100% occluded at the ostium. Sluggish flow noted into obtuse marginal 1 branch which appears to be the culprit vessel for acute MI.
Left subclavian selective angiography revealed patent left subclavian artery and IMA.
Left ventriculogram: Left ventricular cavity was entered using 5 French JR4 diagnostic catheter and LVEDP was measured at 5 mmHg.
The patient was then transferred to the recovery area in stable condition:
Summary conclusion:
1. Multivessel CAD
2. Hypertension
3. Dyslipidemia
4. Type 2 diabetes mellitus
5. CKD
6. NSTEMI
Recommendation:
Recommend CT surgery evaluation for CABG.
thanks in advance
i am thinking of 93459 to be billed. physician has billed 93458, 36225
pl help with coding
The left ventricular pressure was 5 mmHg. The aortic pressure was 137/65 mmHg.
Coronary Angiography:
Right coronary artery is 100% occluded at the ostium. Distal vessel is filling via left-to-right collaterals.
Left Main is angiographically normal.
Left anterior descending is a medium to large caliber vessel with ostial 60 to 70% stenosis, mild to moderate diffuse mid vessel disease, patent distal segment. This is a type III wraparound LAD. LAD is providing collaterals to distal RCA.
Diagonal 1 is a small to medium caliber vessel with ostial 50% stenosis, patent mid to distal segment. Diagonal 2 is a small caliber vessel appears angiographically normal.
Left circumflex is 100% occluded at the ostium. Sluggish flow noted into obtuse marginal 1 branch which appears to be the culprit vessel for acute MI.
Left subclavian selective angiography revealed patent left subclavian artery and IMA.
Left ventriculogram: Left ventricular cavity was entered using 5 French JR4 diagnostic catheter and LVEDP was measured at 5 mmHg.
The patient was then transferred to the recovery area in stable condition:
Summary conclusion:
1. Multivessel CAD
2. Hypertension
3. Dyslipidemia
4. Type 2 diabetes mellitus
5. CKD
6. NSTEMI
Recommendation:
Recommend CT surgery evaluation for CABG.
thanks in advance
i am thinking of 93459 to be billed. physician has billed 93458, 36225
pl help with coding