karbaker
Guest
I know I can code 93458,26 59 and 92928 LD
Can I add 92920 for Angio of Circ??? any input will be helpful.
thanks in advance.
Karen
NAME OF THE PROCEDURE:
1. Left heart catheterization.
2. Left ventriculography.
3. Selective coronary angiography.
4. Percutaneous transluminal coronary angioplasty of LAD ostial
stenosis.
5. Deployment of a 3.5 mm x 9 mm resolute integrity Medtronic drug-
eluting stent into LAD ostial stenosis.
6. Post dilatation of the LAD stent utilizing a 4 mm Quantum balloon.
7. Post dilatation of the ostial circumflex lesion through the stent
strut utilizing a 3 mm Quantum balloon.
SPECIAL NOTE: Please note that this was a complex lesion and this was a
complex intervention. The patient demonstrated high-grade eccentric
ostial LAD lesion. This was right at the bifurcation of the left main
into the LAD and the circ. Location of the lesion posed a significant
challenge for this intervention. Decision making was complex. The
first stent to the LAD lesion and due to the plaque shift, we
postdilated the circ through the stent strut. Multiple balloon
catheters were required. Additional procedural time was needed to
complete the intervention. Final outcome was good with good results.
DESCRIPTION OF PROCEDURE: After proper explanation of the procedures,
indications, risks, and benefits, an informed consent is obtained from
Mr. and is brought over to cath lab in fasting state. The
patient is prepped and draped in usual sterile fashion. IV conscious
sedation is induced using cath lab protocol. Right groin area is
prepped and draped in usual sterile fashion. It is infiltrated
approximately 10 cc of 1% lidocaine and satisfactory. Local anesthesia
is achieved. Right femoral artery is cannulated using 18-gauge needle,
and a 6-French arterial sheath is placed. Sheath is flushed.
Left heart catheterization, left ventriculography, selective coronary
angiography is then performed using 6-French pigtail catheter 6-French
Judkins catheters. At the end of angiography, catheter is removed.
Sheath is flushed. Findings are reviewed. The patient tolerated the
procedure very well without any complications.
cATH FINDINGS: Hemodynamic Data: Left ventricle end-diastolic pressure
in basal condition was 15 mmHg. There is no gradient across aortic
valve.
Left ventriculography demonstrated normal size left ventricle with
normal LV systolic function.
Selective coronary angiography demonstrated right coronary dominance.
Right coronary gave rise to PDA and posterolateral left ventricular
branches. Mild to moderate atherosclerosis is seen in the distribution
of right coronary artery and its branches but no critical lesions are
seen.
Selective angiography of the left system demonstrated large left main
without any stenosis. Left main gave rise to LAD, diagonal, circ,
obtuse marginal system. Ostium of the LAD demonstrated complex
eccentric 80% ostial stenosis. Mid LAD had a stent at the site of
bifurcation of the diagonal branch. This stent was carefully examined.
There appears to be mild-to-moderate in-stent restenosis within the LAD
stent and ostium of the diagonal; however, no critical lesions are seen
and the in-stent restenosis appears to be may be 30% in severity without
critical obstruction. Circumflex was a nondominant vessel giving rise
to an OM branch which was patent without any stenosis.
CONCLUSIONS: In summary, the patient demonstrates:
1. Normal hemodynamics.
2. Normal LV systolic function.
3. Mild-to-moderate atherosclerosis in the right coronary artery and a
complex high-grade 80% ostial LAD lesion and mild-to-moderate in-
stent restenosis in the LAD.
DISCUSSION AND RECOMMENDATIONS: After carefully reviewing these
findings, decision was made to proceed with the angioplasty and stenting
of ostial LAD lesion.
The patient was started on Angiomax infusion in the cath lab per
protocol. Utilizing a 6-French CLS 3.5 angioplasty guide, left main was
engaged using 0.014 ChoICE PT wire. LAD lesion was crossed. Over the
wire we delivered a 3.5 x 9 resolute Medtronic drug-eluting stent. This
stent was delivered across the ostial LAD lesion and after carefully
confirming the stent position in multiple orthogonal views, the stent
was deployed here by inflating balloon at a maximum of 16 atmospheres of
pressure. Balloon was deflated, removed, and cineangiograms were taken
which showed satisfactory stent deployment; however, there appeared to
be a plaque shift into the ostium of the circumflex and the ostium of
the circumflex appeared to be covered by the stent strut. At this point
of time, we elected to postdilate the LAD stent. We utilized a 4 mm
quantum and we used a 4 x 8 quantum and postdilated LAD stent at 12
atmospheres. After adequate postdilatation, we directed the LAD
guidewire into the circumflex through the stent strut, and we delivered
a 3 x 8 Quantum balloon into the circ ostium through the stent strut and
we dilated this area at 12 atmosphere pressures with a complete balloon
expansion. Balloon was deflated, removed, and final angiograms were
taken in multiple views which showed excellent patency both into the LAD
and the circumflex with excellent stent deployment. Brisk antegrade
flow in both vessels without any residual stenosis, thrombus, or
dissection. Balloon angioplasty wire and guide catheter withdrawn
sheath is shown in. The patient will be admitted to telemetry unit for
post intervention care and observation and will be continued on aspirin
and Plavix.
Can I add 92920 for Angio of Circ??? any input will be helpful.
thanks in advance.
Karen
NAME OF THE PROCEDURE:
1. Left heart catheterization.
2. Left ventriculography.
3. Selective coronary angiography.
4. Percutaneous transluminal coronary angioplasty of LAD ostial
stenosis.
5. Deployment of a 3.5 mm x 9 mm resolute integrity Medtronic drug-
eluting stent into LAD ostial stenosis.
6. Post dilatation of the LAD stent utilizing a 4 mm Quantum balloon.
7. Post dilatation of the ostial circumflex lesion through the stent
strut utilizing a 3 mm Quantum balloon.
SPECIAL NOTE: Please note that this was a complex lesion and this was a
complex intervention. The patient demonstrated high-grade eccentric
ostial LAD lesion. This was right at the bifurcation of the left main
into the LAD and the circ. Location of the lesion posed a significant
challenge for this intervention. Decision making was complex. The
first stent to the LAD lesion and due to the plaque shift, we
postdilated the circ through the stent strut. Multiple balloon
catheters were required. Additional procedural time was needed to
complete the intervention. Final outcome was good with good results.
DESCRIPTION OF PROCEDURE: After proper explanation of the procedures,
indications, risks, and benefits, an informed consent is obtained from
Mr. and is brought over to cath lab in fasting state. The
patient is prepped and draped in usual sterile fashion. IV conscious
sedation is induced using cath lab protocol. Right groin area is
prepped and draped in usual sterile fashion. It is infiltrated
approximately 10 cc of 1% lidocaine and satisfactory. Local anesthesia
is achieved. Right femoral artery is cannulated using 18-gauge needle,
and a 6-French arterial sheath is placed. Sheath is flushed.
Left heart catheterization, left ventriculography, selective coronary
angiography is then performed using 6-French pigtail catheter 6-French
Judkins catheters. At the end of angiography, catheter is removed.
Sheath is flushed. Findings are reviewed. The patient tolerated the
procedure very well without any complications.
cATH FINDINGS: Hemodynamic Data: Left ventricle end-diastolic pressure
in basal condition was 15 mmHg. There is no gradient across aortic
valve.
Left ventriculography demonstrated normal size left ventricle with
normal LV systolic function.
Selective coronary angiography demonstrated right coronary dominance.
Right coronary gave rise to PDA and posterolateral left ventricular
branches. Mild to moderate atherosclerosis is seen in the distribution
of right coronary artery and its branches but no critical lesions are
seen.
Selective angiography of the left system demonstrated large left main
without any stenosis. Left main gave rise to LAD, diagonal, circ,
obtuse marginal system. Ostium of the LAD demonstrated complex
eccentric 80% ostial stenosis. Mid LAD had a stent at the site of
bifurcation of the diagonal branch. This stent was carefully examined.
There appears to be mild-to-moderate in-stent restenosis within the LAD
stent and ostium of the diagonal; however, no critical lesions are seen
and the in-stent restenosis appears to be may be 30% in severity without
critical obstruction. Circumflex was a nondominant vessel giving rise
to an OM branch which was patent without any stenosis.
CONCLUSIONS: In summary, the patient demonstrates:
1. Normal hemodynamics.
2. Normal LV systolic function.
3. Mild-to-moderate atherosclerosis in the right coronary artery and a
complex high-grade 80% ostial LAD lesion and mild-to-moderate in-
stent restenosis in the LAD.
DISCUSSION AND RECOMMENDATIONS: After carefully reviewing these
findings, decision was made to proceed with the angioplasty and stenting
of ostial LAD lesion.
The patient was started on Angiomax infusion in the cath lab per
protocol. Utilizing a 6-French CLS 3.5 angioplasty guide, left main was
engaged using 0.014 ChoICE PT wire. LAD lesion was crossed. Over the
wire we delivered a 3.5 x 9 resolute Medtronic drug-eluting stent. This
stent was delivered across the ostial LAD lesion and after carefully
confirming the stent position in multiple orthogonal views, the stent
was deployed here by inflating balloon at a maximum of 16 atmospheres of
pressure. Balloon was deflated, removed, and cineangiograms were taken
which showed satisfactory stent deployment; however, there appeared to
be a plaque shift into the ostium of the circumflex and the ostium of
the circumflex appeared to be covered by the stent strut. At this point
of time, we elected to postdilate the LAD stent. We utilized a 4 mm
quantum and we used a 4 x 8 quantum and postdilated LAD stent at 12
atmospheres. After adequate postdilatation, we directed the LAD
guidewire into the circumflex through the stent strut, and we delivered
a 3 x 8 Quantum balloon into the circ ostium through the stent strut and
we dilated this area at 12 atmosphere pressures with a complete balloon
expansion. Balloon was deflated, removed, and final angiograms were
taken in multiple views which showed excellent patency both into the LAD
and the circumflex with excellent stent deployment. Brisk antegrade
flow in both vessels without any residual stenosis, thrombus, or
dissection. Balloon angioplasty wire and guide catheter withdrawn
sheath is shown in. The patient will be admitted to telemetry unit for
post intervention care and observation and will be continued on aspirin
and Plavix.