amym
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Should I be billing this as 92928-LC, 92921-LD and 93458-26-59? Thanks for your help.
SUMMARY:
-- 1ST LESION INTERVENTIONS:
-- A percutaneous intervention was performed on the lesion in the
proximal RCA.
-- 2ND LESION INTERVENTIONS:
-- A percutaneous intervention was performed on the 95 % lesion in the
1st obtuse marginal.
PROCEDURES PERFORMED:
-- Left heart catheterization with ventriculography.
-- Left coronary angiography.
-- Right coronary angiography.
-- Interventional Flow Wire.
-- PTCA.
-- Coronary Drug Eluding Stent Placement.
-- Intervention on proximal RCA: percutaneous intervention.
-- Intervention on OM1: percutaneous intervention.
INDICATIONS: Coronary artery disease: abnormal stress test.
HEMODYNAMICS: Hemodynamic assessment demonstrates normal hemodynamics.
CORONARY VESSELS: The coronary circulation is right dominant.
(1) Left main is patent with no significant disease
(2) LAD is patent with no significant disease
(3) LCX is patent with no significant disease- OM1 is a moderate sized
vessel with proximal 95% stenosis.
(4) RCA has a 40-45 percent mid lesion.
(5) LVgram not performed.
(6) FFR of RCA is 0.89
(7) PCI of OM1 with a 2.25 x 12mm DES.
. Ostial left main: Normal. Proximal left main: Normal. Mid left main:
Normal. Distal left main: Normal. Proximal LAD: Normal. Mid LAD: Normal.
Distal LAD: Normal. Proximal circumflex: Normal. Mid circumflex: Normal.
Distal circumflex: Normal. 1st obtuse marginal: There was a 95 % stenosis.
Ostial RCA: Normal. Proximal RCA: Normal. There was a 40 % stenosis. Mid
RCA: Normal. Distal RCA: Normal. Angiography showed minor luminal
irregularities. Right posterolateral segment: Normal.
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. Oxygen 2 L/min.
-- Right radial 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 catheter was
advanced over the wire into the vessel.
-- 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. Ventriculography was performed using power injection of contrast
agent. 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.
LESION #1 INTERVENTION: A percutaneous intervention was performed on the
lesion in the proximal RCA. There was no dissection.
-- Vessel setup was performed. A 175cm Certus Pressure wire was used to
cross the lesion.
-- Vessel setup was performed. A Runway 6FR FR4 guiding catheter was used
to cannulate the vessel.
-- Steady baseline values were obtained. Mean arterial pressure and mean
distal coronary pressures were then obtained at maximum hyperemia.
LESION #2 INTERVENTION: A percutaneous intervention was performed on the
95 % lesion in the 1st obtuse marginal. There was no dissection.
-- Vessel setup was performed. A Runway 6FR LBU 3.5 guiding catheter was
used to cannulate the vessel.
-- Vessel setup was performed. A 175cm Certus Pressure wire was used to
cross the lesion.
-- , using a Emerge Rx 2.0 x 12mm balloon, with 1 inflations and a
maximum inflation pressure of 14 atm.
-- Vessel setup was performed. A Runway 6FR LBU 3.5 guiding catheter was
used to cannulate the vessel.
-- Vessel setup was performed. A BMW HT 190cm wire was used to cross the
lesion.
-- Vessel setup was performed. A 175cm Certus Pressure wire was used to
cross the lesion.
-- A Resolute Integrity Rx 2.25 x 14mm drug-eluting stent at a maximum
inflation pressure of 16 atm.
CARDIAC INTERVENTIONS
-- Interventional Flow Wire.
-- PTCA.
-- Coronary Drug Eluding Stent Placement.
COMPLICATIONS:
None occurred during the cath lab visit.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
Test started at 07:49. Test concluded at 09:13. RADIATION EXPOSURE:
Fluoroscopy time: 19.2 min.
HEMOSTASIS:
The site was compressed with a Hemoband device. Hemostasis was successful.
MEDICATIONS GIVEN:
Midazolam, 1 mg, IV, at 07:49.
Fentanyl, 50 mcg, IV, at 07:49.
Midazolam, 1 mg, IV, at 08:18.
Fentanyl, 50 mcg, IV, at 08:18.
Fentanyl, 50 mcg, IV, at 08:25.
Midazolam, 1 mg, IV, at 08:25.
Nitroglycerin, 100 mcg, IA, at 07:58.
Verapamil (Isoptin, Calan, Covera), 2.5 mcg, IA, at 07:58.
Adenosine (Adenocard), 90 mcg, intracoronary, at 08:28.
Adenosine (Adenocard), 120 mcg, intracoronary, at 08:31.
Heparin, 2500 units, IA, last dose at 07:58.
Heparin, 8000 units, IV, last dose at 08:16.
Heparin, 5000 units, IV, last dose at 08:47.
1% Lidocaine, 5 ml, subcutaneously, at 07:57.
Prasugrel, 60 mg, PO, at 09:15.
CONTRAST GIVEN:
Omnipaque 200 ml.
STUDY DIAGRAM
Angiographic findings
Native coronary lesions:
7OM1: Lesion 1: 95 % stenosis.
7Proximal RCA: Lesion 1: 40 % stenosis.
Intervention results
Native coronary lesions:
7 percutaneous intervention of proximal RCA.
7percutaneous intervention of the 95 % stenosis in OM1. Stent: Resolute
Integrity Rx 2.25 x 14mm drug-eluting.
HEMODYNAMIC TABLES
Pressures: Baseline
Pressures: - HR: 67
Pressures: - Rhythm:
Pressures: -- Aortic Pressure (S/D/M): 122/65/90
Outputs: Baseline
Outputs: -- CALCULATIONS: Age in years: 70.64
Outputs: -- CALCULATIONS: Body Surface Area: 1.95
Outputs: -- CALCULATIONS: Height in cm: 173.00
Outputs: -- CALCULATIONS: Sex: Male
Outputs: -- CALCULATIONS: Weight in kg: 80.70
SUMMARY:
-- 1ST LESION INTERVENTIONS:
-- A percutaneous intervention was performed on the lesion in the
proximal RCA.
-- 2ND LESION INTERVENTIONS:
-- A percutaneous intervention was performed on the 95 % lesion in the
1st obtuse marginal.
PROCEDURES PERFORMED:
-- Left heart catheterization with ventriculography.
-- Left coronary angiography.
-- Right coronary angiography.
-- Interventional Flow Wire.
-- PTCA.
-- Coronary Drug Eluding Stent Placement.
-- Intervention on proximal RCA: percutaneous intervention.
-- Intervention on OM1: percutaneous intervention.
INDICATIONS: Coronary artery disease: abnormal stress test.
HEMODYNAMICS: Hemodynamic assessment demonstrates normal hemodynamics.
CORONARY VESSELS: The coronary circulation is right dominant.
(1) Left main is patent with no significant disease
(2) LAD is patent with no significant disease
(3) LCX is patent with no significant disease- OM1 is a moderate sized
vessel with proximal 95% stenosis.
(4) RCA has a 40-45 percent mid lesion.
(5) LVgram not performed.
(6) FFR of RCA is 0.89
(7) PCI of OM1 with a 2.25 x 12mm DES.
. Ostial left main: Normal. Proximal left main: Normal. Mid left main:
Normal. Distal left main: Normal. Proximal LAD: Normal. Mid LAD: Normal.
Distal LAD: Normal. Proximal circumflex: Normal. Mid circumflex: Normal.
Distal circumflex: Normal. 1st obtuse marginal: There was a 95 % stenosis.
Ostial RCA: Normal. Proximal RCA: Normal. There was a 40 % stenosis. Mid
RCA: Normal. Distal RCA: Normal. Angiography showed minor luminal
irregularities. Right posterolateral segment: Normal.
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. Oxygen 2 L/min.
-- Right radial 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 catheter was
advanced over the wire into the vessel.
-- 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. Ventriculography was performed using power injection of contrast
agent. 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.
LESION #1 INTERVENTION: A percutaneous intervention was performed on the
lesion in the proximal RCA. There was no dissection.
-- Vessel setup was performed. A 175cm Certus Pressure wire was used to
cross the lesion.
-- Vessel setup was performed. A Runway 6FR FR4 guiding catheter was used
to cannulate the vessel.
-- Steady baseline values were obtained. Mean arterial pressure and mean
distal coronary pressures were then obtained at maximum hyperemia.
LESION #2 INTERVENTION: A percutaneous intervention was performed on the
95 % lesion in the 1st obtuse marginal. There was no dissection.
-- Vessel setup was performed. A Runway 6FR LBU 3.5 guiding catheter was
used to cannulate the vessel.
-- Vessel setup was performed. A 175cm Certus Pressure wire was used to
cross the lesion.
-- , using a Emerge Rx 2.0 x 12mm balloon, with 1 inflations and a
maximum inflation pressure of 14 atm.
-- Vessel setup was performed. A Runway 6FR LBU 3.5 guiding catheter was
used to cannulate the vessel.
-- Vessel setup was performed. A BMW HT 190cm wire was used to cross the
lesion.
-- Vessel setup was performed. A 175cm Certus Pressure wire was used to
cross the lesion.
-- A Resolute Integrity Rx 2.25 x 14mm drug-eluting stent at a maximum
inflation pressure of 16 atm.
CARDIAC INTERVENTIONS
-- Interventional Flow Wire.
-- PTCA.
-- Coronary Drug Eluding Stent Placement.
COMPLICATIONS:
None occurred during the cath lab visit.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
Test started at 07:49. Test concluded at 09:13. RADIATION EXPOSURE:
Fluoroscopy time: 19.2 min.
HEMOSTASIS:
The site was compressed with a Hemoband device. Hemostasis was successful.
MEDICATIONS GIVEN:
Midazolam, 1 mg, IV, at 07:49.
Fentanyl, 50 mcg, IV, at 07:49.
Midazolam, 1 mg, IV, at 08:18.
Fentanyl, 50 mcg, IV, at 08:18.
Fentanyl, 50 mcg, IV, at 08:25.
Midazolam, 1 mg, IV, at 08:25.
Nitroglycerin, 100 mcg, IA, at 07:58.
Verapamil (Isoptin, Calan, Covera), 2.5 mcg, IA, at 07:58.
Adenosine (Adenocard), 90 mcg, intracoronary, at 08:28.
Adenosine (Adenocard), 120 mcg, intracoronary, at 08:31.
Heparin, 2500 units, IA, last dose at 07:58.
Heparin, 8000 units, IV, last dose at 08:16.
Heparin, 5000 units, IV, last dose at 08:47.
1% Lidocaine, 5 ml, subcutaneously, at 07:57.
Prasugrel, 60 mg, PO, at 09:15.
CONTRAST GIVEN:
Omnipaque 200 ml.
STUDY DIAGRAM
Angiographic findings
Native coronary lesions:
7OM1: Lesion 1: 95 % stenosis.
7Proximal RCA: Lesion 1: 40 % stenosis.
Intervention results
Native coronary lesions:
7 percutaneous intervention of proximal RCA.
7percutaneous intervention of the 95 % stenosis in OM1. Stent: Resolute
Integrity Rx 2.25 x 14mm drug-eluting.
HEMODYNAMIC TABLES
Pressures: Baseline
Pressures: - HR: 67
Pressures: - Rhythm:
Pressures: -- Aortic Pressure (S/D/M): 122/65/90
Outputs: Baseline
Outputs: -- CALCULATIONS: Age in years: 70.64
Outputs: -- CALCULATIONS: Body Surface Area: 1.95
Outputs: -- CALCULATIONS: Height in cm: 173.00
Outputs: -- CALCULATIONS: Sex: Male
Outputs: -- CALCULATIONS: Weight in kg: 80.70
