bevann0402@bellsouth.net
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it is starting to make a little more sense to me, but I am still getting stumped.
I came up with cpt code 92928, but I do not know if this is right or if more codes are needed.
procedure performed:
1. 6 French sheath placement in the right common femoral artery with a moderate amount of difficulty
2. coronary angiography
3. PCI bare metal stenting in the RCA
4. right common femoral artery angiography
5. 6 French angio-seal in the right common femoral artery for hemostatsis no hematoma
indication: chest pain, inferior wall ischemia seen on nuclear stress
details of coronary angiography and PCI were explained to the patient in great detail including risk factors. underwent 6 French sheath placement in the right common femoral artery with a moderate amount of difficulty. coronary angiography was then performed. 1. the left main is mildly calcified. it is short, large, no significant occlusions. 2. the left circumflex is mildly calcified, large, nondominant. tapers to a small vessel proximally. in the proper left circ, there is a 40% mid lesion seen. 3. obtuse marginal #1 is a medium sized vessel w/o significant occlusions. 4. obtuse marginal #2 is a large vessel with 30% diffuse proximal to mid stenosis. 5. the patient underwent angiography of the LAD which was large, showing 30% proximal diffuse stenosis seen. 6. diagonal artery #1 is a medium size vessel w/o significant occlusions. 7. the RCA is a medium sized vessel it is calcified proximal to mid. the mid vessel is showing a 60% to 70% hazy reactive lesion and then there is a 2nd tandem lesion of 50% noted beyond the RCA. 8. the PDA is a medium size vessel w/o significant occlusions. 9. angiography of the right common femoral artery showed a large vessel with 10% to 20% stenosis, due to high _____. angio-seal was recommended, at the close of the case.
severe lesion detected in the RCA. patient recommended PCI. angiomax was started. the lesion was wired utilizing a prowater wire. we attempted to palce a stent first in a direct stenting fashion, but unable to proceed with getting the stent down the vessel. it got stuck at the severe lesion. we also tried a headliner, but this was unsuccessful. we then buddied the RCA with a 2nd prowater buddy wire and then we were able to balloon with a 2.0 x 10 mm balloon. it was a severe lesion. therefore 14 atmospheres for 30 seconds. this was removed from the body. we took an Integrity 2.5 x 12 mm stent and placed this across the pre dilatated lesion and deployed at 12 atmospheres for 30 seconds. final angiography was performed with and without wire in place. the 60% to 70% hazy lesion reduced to less than 10%. no reactivity noted, no dissection. angiography with and without medical therapy here since such great difficulty and excessive dye was used to place the original stent to this severe AV lesion. at the close of the cases, we did place a 6 French angio-seal to the right common femoral artery. good hemostasis, no hematoma. if symptoms persist, I would return for a flow wire to the RCA and consider stenting the second tandem lesion. it will require a more appropriate guide with more backup support, probably an 8 French JR 4.0 or an allRight guide. more than likely the delivery of the 2nd stent to the 2nd tandem lesion would also require a buddy wire and nitroglycerin and preparation prior to placing the stent.
thanks for all the help and hints to look for!!
Beverly
I came up with cpt code 92928, but I do not know if this is right or if more codes are needed.
procedure performed:
1. 6 French sheath placement in the right common femoral artery with a moderate amount of difficulty
2. coronary angiography
3. PCI bare metal stenting in the RCA
4. right common femoral artery angiography
5. 6 French angio-seal in the right common femoral artery for hemostatsis no hematoma
indication: chest pain, inferior wall ischemia seen on nuclear stress
details of coronary angiography and PCI were explained to the patient in great detail including risk factors. underwent 6 French sheath placement in the right common femoral artery with a moderate amount of difficulty. coronary angiography was then performed. 1. the left main is mildly calcified. it is short, large, no significant occlusions. 2. the left circumflex is mildly calcified, large, nondominant. tapers to a small vessel proximally. in the proper left circ, there is a 40% mid lesion seen. 3. obtuse marginal #1 is a medium sized vessel w/o significant occlusions. 4. obtuse marginal #2 is a large vessel with 30% diffuse proximal to mid stenosis. 5. the patient underwent angiography of the LAD which was large, showing 30% proximal diffuse stenosis seen. 6. diagonal artery #1 is a medium size vessel w/o significant occlusions. 7. the RCA is a medium sized vessel it is calcified proximal to mid. the mid vessel is showing a 60% to 70% hazy reactive lesion and then there is a 2nd tandem lesion of 50% noted beyond the RCA. 8. the PDA is a medium size vessel w/o significant occlusions. 9. angiography of the right common femoral artery showed a large vessel with 10% to 20% stenosis, due to high _____. angio-seal was recommended, at the close of the case.
severe lesion detected in the RCA. patient recommended PCI. angiomax was started. the lesion was wired utilizing a prowater wire. we attempted to palce a stent first in a direct stenting fashion, but unable to proceed with getting the stent down the vessel. it got stuck at the severe lesion. we also tried a headliner, but this was unsuccessful. we then buddied the RCA with a 2nd prowater buddy wire and then we were able to balloon with a 2.0 x 10 mm balloon. it was a severe lesion. therefore 14 atmospheres for 30 seconds. this was removed from the body. we took an Integrity 2.5 x 12 mm stent and placed this across the pre dilatated lesion and deployed at 12 atmospheres for 30 seconds. final angiography was performed with and without wire in place. the 60% to 70% hazy lesion reduced to less than 10%. no reactivity noted, no dissection. angiography with and without medical therapy here since such great difficulty and excessive dye was used to place the original stent to this severe AV lesion. at the close of the cases, we did place a 6 French angio-seal to the right common femoral artery. good hemostasis, no hematoma. if symptoms persist, I would return for a flow wire to the RCA and consider stenting the second tandem lesion. it will require a more appropriate guide with more backup support, probably an 8 French JR 4.0 or an allRight guide. more than likely the delivery of the 2nd stent to the 2nd tandem lesion would also require a buddy wire and nitroglycerin and preparation prior to placing the stent.
thanks for all the help and hints to look for!!
Beverly
