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Dr did a TEE/Cardioversion on pt and then returned to do a LHC
INDICATIONS: Shortness of breath, angina pectoris.
PROCEDURE PERFORMED: Left heart catheterization, selective coronary angiography, left ventriculography
HISTORY OF PRESENT ILLNESS: The patient is a 73-year-old with history of diabetes, dyslipidemia who had presented with progressive symptoms of shortness of breath to his primary care doctor. He was determined to have a newly appreciated yet rate
controlled atrial flutter. He was placed on Pradaxa and a beta-blocker; however, presented to emergency department with progressive shortness of breath. He was ruled out for MI but with persistent shortness of breath, he was transferred to
for treatment of his arrhythmia evaluation for coronary artery disease. Earlier today he underwent a transesophageal echo that demonstrated no significant valve disease, preserved left ventricular function, no left atrial clot and
underwent successful cardioversion to sinus rhythm. He still had the sensation of shortness of breath and therefore was referred for diagnostic angiography.
PROCEDURE: Informed consent was obtained, the patient understood the risks, benefits and alternatives of the procedure and agreed to proceed with the procedure. The right wrist was prepped in the usual sterile fashion and 2% lidocaine infused
subcutaneously until adequate anesthesia was obtained. Right radial artery was accessed using modified Seldinger technique with a 6 French 250 mm Glidesheath was placed without complication. Diagnostic 6 French Jacky catheter was used to perform
selective coronary angiography, left ventriculography left heart catheterization. At the conclusion of the procedure, a TR band was used for hemostasis.
HEMODYNAMICS: Left ventricular end-diastolic pressure measured 17 mmHg. There is no transaortic gradient angiogram pullback.
LEFT VENTRICULOGRAPHY: Demonstrated preserved left ventricular function, ejection fraction of 55-60%.
CORONARY ANGIOGRAPHY:
LEFT MAIN: No significant disease.
LAD: No significant disease with a first diagonal without significant.
LEFT CIRCUMFLEX: Gave off two prominent marginal branches without significant disease.
RCA: Dominant vessel with mild disease with a prominent PL and PDA branches without significant obstruction.
SUMMARY:
1. No obstructive coronary artery disease.
2. Normal left ventricular filling pressures, normal left ventricular function.
CLINICAL PATHWAY: We are reassured that the patient does not have obstructive coronary disease. We hope with resolution of AV synchrony with cardioversion to sinus rhythm will improve his symptoms. He is also of recovering from an upper respiratory
tract infection and may be having symptoms of bronchitis accounting for his shortness of breath; however, his hemodynamic assessment was otherwise stable without evidence of heart failure.
Do I code it
93458-26-78
93312-26
93325-26
93320-26
92960
Thank you Nancy
INDICATIONS: Shortness of breath, angina pectoris.
PROCEDURE PERFORMED: Left heart catheterization, selective coronary angiography, left ventriculography
HISTORY OF PRESENT ILLNESS: The patient is a 73-year-old with history of diabetes, dyslipidemia who had presented with progressive symptoms of shortness of breath to his primary care doctor. He was determined to have a newly appreciated yet rate
controlled atrial flutter. He was placed on Pradaxa and a beta-blocker; however, presented to emergency department with progressive shortness of breath. He was ruled out for MI but with persistent shortness of breath, he was transferred to
for treatment of his arrhythmia evaluation for coronary artery disease. Earlier today he underwent a transesophageal echo that demonstrated no significant valve disease, preserved left ventricular function, no left atrial clot and
underwent successful cardioversion to sinus rhythm. He still had the sensation of shortness of breath and therefore was referred for diagnostic angiography.
PROCEDURE: Informed consent was obtained, the patient understood the risks, benefits and alternatives of the procedure and agreed to proceed with the procedure. The right wrist was prepped in the usual sterile fashion and 2% lidocaine infused
subcutaneously until adequate anesthesia was obtained. Right radial artery was accessed using modified Seldinger technique with a 6 French 250 mm Glidesheath was placed without complication. Diagnostic 6 French Jacky catheter was used to perform
selective coronary angiography, left ventriculography left heart catheterization. At the conclusion of the procedure, a TR band was used for hemostasis.
HEMODYNAMICS: Left ventricular end-diastolic pressure measured 17 mmHg. There is no transaortic gradient angiogram pullback.
LEFT VENTRICULOGRAPHY: Demonstrated preserved left ventricular function, ejection fraction of 55-60%.
CORONARY ANGIOGRAPHY:
LEFT MAIN: No significant disease.
LAD: No significant disease with a first diagonal without significant.
LEFT CIRCUMFLEX: Gave off two prominent marginal branches without significant disease.
RCA: Dominant vessel with mild disease with a prominent PL and PDA branches without significant obstruction.
SUMMARY:
1. No obstructive coronary artery disease.
2. Normal left ventricular filling pressures, normal left ventricular function.
CLINICAL PATHWAY: We are reassured that the patient does not have obstructive coronary disease. We hope with resolution of AV synchrony with cardioversion to sinus rhythm will improve his symptoms. He is also of recovering from an upper respiratory
tract infection and may be having symptoms of bronchitis accounting for his shortness of breath; however, his hemodynamic assessment was otherwise stable without evidence of heart failure.
Do I code it
93458-26-78
93312-26
93325-26
93320-26
92960
Thank you Nancy