amym
Guest
Would it be appropriate to code this as 92928-RC and 92978-26? Or am I missing something?
SUMMARY:
-- HEMODYNAMICS:
-- Hemodynamic assessment demonstrates moderate to severe systemic
hypertension and normal LVEDP.
-- 1ST LESION INTERVENTIONS:
-- A stent was performed on the 95 % lesion in the mid RCA. Following
intervention there was a 0 % residual stenosis.
IVUS of dLM and pLAD performed, which was not significant
-- Intravascular ultrasound was performed using a
Runway 6FR LBU 3.5
catheter over a previously placed guidewire. The target lesion had a
length of 15 mm and a diameter stenosis of 60 %. No dissection. Eccentric
plaque present. No thrombus present. Based on the results of this study,
the lesion was judged to be non-significant and no intervention was
performed.
-- RECOMMENDATIONS:
-- S/p BMS 3.0x30 in mRCA
ASA/Plavix
Risk factor modifcation
PROCEDURES PERFORMED:
-- Interventional IVUS.
-- Intervention on mid RCA: stent.
RECOMMENDATIONS:
EF60%, mild MR, R dominant, 40% distal LM, 70% ostial LAD, LI of LCX, 90%
mid RCA stenosis w/possible thrombus w/L to R collaterals. Plan is to do
IVUS of ostial LAD and decide on revascularization option.
S/p BMS 3.0x30 in mRCA
ASA/Plavix
Risk factor modifcation
INDICATIONS: preop, abnl TST
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.
LESION INTERVENTION: A stent was performed on the 95 % lesion in the mid
RCA. Following intervention there was a 0 % residual stenosis. IVUS of dLM
and pLAD performed, which was not significant There was no dissection.
-- Balloon angioplasty was performed, using a Emerge Rx 2.75 x 15mm
balloon, with 2 inflations and a maximum inflation pressure of 10 atm.
During the procedure, the previous guider was changed for a Runway 6FR IM
guider, and a new Runthrough 180 cm wire was advanced across the lesion.
-- A Integrity 3.0 x 30 bare-metal stent was placed across the lesion and
deployed at a maximum inflation pressure of 10 atm.
-- Intravascular ultrasound was performed using a Runway 6FR LBU 3.5
catheter over a previously placed guidewire. The target lesion had a
length of 15 mm and a diameter stenosis of 60 %. No dissection. Eccentric
plaque present. No thrombus present. Based on the results of this study,
the lesion was judged to be non-significant and no intervention was
performed.
-- Balloon angioplasty was performed, with 2 inflations and a maximum
inflation pressure of 10 atm.
-- Balloon angioplasty was performed, using a NC Quantum 3.0 x 20
balloon, with 3 inflations and a maximum inflation pressure of 20 atm.
-- Balloon angioplasty was performed, using a NC Quantum 3.5 x 15
balloon, with 1 inflations and a maximum inflation pressure of 20 atm.
CARDIAC INTERVENTIONS
-- Interventional IVUS.
COMPLICATIONS:
There were no adverse outcomes.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
Test started at 15:55. Test concluded at 18:05. RADIATION EXPOSURE:
Fluoroscopy time: 26.2 min.
STUDY DIAGRAM
Angiographic findings
Native coronary lesions:
7Left main: Lesion 1: 40 % stenosis.
7LAD: Lesion 1: 70 % stenosis.
7RCA: Lesion 1: 90 % stenosis.
7Mid RCA: Lesion 1: 95 % stenosis.
Intervention results
Native coronary lesions:
7stent of the 95 % stenosis in mid RCA. 0 % residual stenosis. Stent:
Integrity 3.0 x 30 bare-metal.
SUMMARY:
-- HEMODYNAMICS:
-- Hemodynamic assessment demonstrates moderate to severe systemic
hypertension and normal LVEDP.
-- 1ST LESION INTERVENTIONS:
-- A stent was performed on the 95 % lesion in the mid RCA. Following
intervention there was a 0 % residual stenosis.
IVUS of dLM and pLAD performed, which was not significant
-- Intravascular ultrasound was performed using a
Runway 6FR LBU 3.5 catheter over a previously placed guidewire. The target lesion had a
length of 15 mm and a diameter stenosis of 60 %. No dissection. Eccentric
plaque present. No thrombus present. Based on the results of this study,
the lesion was judged to be non-significant and no intervention was
performed.
-- RECOMMENDATIONS:
-- S/p BMS 3.0x30 in mRCA
ASA/Plavix
Risk factor modifcation
PROCEDURES PERFORMED:
-- Interventional IVUS.
-- Intervention on mid RCA: stent.
RECOMMENDATIONS:
EF60%, mild MR, R dominant, 40% distal LM, 70% ostial LAD, LI of LCX, 90%
mid RCA stenosis w/possible thrombus w/L to R collaterals. Plan is to do
IVUS of ostial LAD and decide on revascularization option.
S/p BMS 3.0x30 in mRCA
ASA/Plavix
Risk factor modifcation
INDICATIONS: preop, abnl TST
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.
LESION INTERVENTION: A stent was performed on the 95 % lesion in the mid
RCA. Following intervention there was a 0 % residual stenosis. IVUS of dLM
and pLAD performed, which was not significant There was no dissection.
-- Balloon angioplasty was performed, using a Emerge Rx 2.75 x 15mm
balloon, with 2 inflations and a maximum inflation pressure of 10 atm.
During the procedure, the previous guider was changed for a Runway 6FR IM
guider, and a new Runthrough 180 cm wire was advanced across the lesion.
-- A Integrity 3.0 x 30 bare-metal stent was placed across the lesion and
deployed at a maximum inflation pressure of 10 atm.
-- Intravascular ultrasound was performed using a
Runway 6FR LBU 3.5 catheter over a previously placed guidewire. The target lesion had a
length of 15 mm and a diameter stenosis of 60 %. No dissection. Eccentric
plaque present. No thrombus present. Based on the results of this study,
the lesion was judged to be non-significant and no intervention was
performed.
-- Balloon angioplasty was performed, with 2 inflations and a maximum
inflation pressure of 10 atm.
-- Balloon angioplasty was performed, using a NC Quantum 3.0 x 20
balloon, with 3 inflations and a maximum inflation pressure of 20 atm.
-- Balloon angioplasty was performed, using a NC Quantum 3.5 x 15
balloon, with 1 inflations and a maximum inflation pressure of 20 atm.
CARDIAC INTERVENTIONS
-- Interventional IVUS.
COMPLICATIONS:
There were no adverse outcomes.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
Test started at 15:55. Test concluded at 18:05. RADIATION EXPOSURE:
Fluoroscopy time: 26.2 min.
STUDY DIAGRAM
Angiographic findings
Native coronary lesions:
7Left main: Lesion 1: 40 % stenosis.
7LAD: Lesion 1: 70 % stenosis.
7RCA: Lesion 1: 90 % stenosis.
7Mid RCA: Lesion 1: 95 % stenosis.
Intervention results
Native coronary lesions:
7stent of the 95 % stenosis in mid RCA. 0 % residual stenosis. Stent:
Integrity 3.0 x 30 bare-metal.