OPENSHAW
Guru
Diagnostic Angiogram
Pre-Procedure Diagnosis: Claudication, HTN, abdominal aortic aneurysm
Post-Procedure Diagnosis: Nonobstructive CAD, abdominal aortic aneurysm, nonobstructive diffuse femoral disease
Procedure performed: Selective coronary angiogram of the left main (LM) and right coronary artery (RCA). A left ventriculogram was not performed, LHC. Proximal abdominal Aortogram, distal abdominal aortogram - Both aortograms done in DSA with visualization of the iliac and femoral arteries
Anesthesia Used: IV versed and fentanyl, local 2% lidocaine
Blood Loss: 30 mL
Condition: stable
IV Contrast Used: 160 mL
Complications: none
Procedure and Findings in Detail: The procedure was described to the patient including benefits, risks, and alternatives to the procedure. The patient confirmed understanding. The patient signed the informed consent. He was brought into the cath lab. The bilateral groins were prepped in a sterile fashion, and a sterile drape was placed over the patient.
The right common femoral artery (CFA) was palpated and the region above the artery was anesthetized with 2% local lidocaine. A Cook needle was used to access the right CFA. The wire was visualized under fluoroscopy ascending into the common iliac artery. A 6 French sheath was placed over the wire without difficulty in the normal form and fashion. We also gained accesses to the CFV using a cook needle and a modified Seldinger technique and a 4 french sheath.
A 6 Fr diagnostic JL4 was placed in the ascending aorta directed by a J wire. The J wire was removed, the catheter aspirated to remove any air and flushed with normal saline. The diagnostic catheter engaged the left main without difficulty. The diagnostic evaluation revealed the following:
Left main: short no disease
LAD: no occlusive disease
Diagonals: 50% proximal disease
Circumflex: no occlusive disease
Obtuse marginals: 1 small OM
The diagnostic catheter used for the left coronary was removed from the descending aorta over the J wire. A 6 Ft diagnostic JR4 was placed over the wire and guided to the ascending aorta. The J wire was removed. The catheter was aspirated and flushed with normal saline. The diagnostic evaluation revealed the following:
RCA: proximal plaque, 50% mid RCA - right dom
PDA: no obstructive disease
PLV: no obstructive disease
The RCA catheter was removed from the descending aorta over a J wire. We then advanced a 6french pigtail into the LV to complete the left heart cath and obtain LV pressures and pull back gradient.
LVA: not done
LVEDP 4-20
AO 134/61
No pull back gradient
We then removed the pigtail catheter over a J wire and advanced a marker pigtail catheter into the abdominal aorta to the level of the renal arteries. We then removed the J wire and after flushing did a power injection of the proximal aorta from the renals to the iliacs. We then brought the pigtail catheter to the aortoiliac bifurcation and again under DSA did a study of the distal aorta, iliacs and femorals.
Abdominal aortogram:
Patent single renal arteries, normal
Moderate size aneurysm
Diffuse arthrosclerotic disease of iliacs
Ulcerated lesion right iliac 50% stenosis
Femoral diffuse arthrosclerosis
The marker pigtail was then removed over a J wire.
The patient was in hemodynamically stable condition throughout entirety of the procedure. The sheaths were removed and manual pressure was held for 20 mins and application of a Dstat patch. The patient will be on bed rest for 4 hours. He was given a 500cc infusion for reno protection and 1 dose of diamox at DC.
Summary:
Nonobstructive CAD
Abdominal aortic aneurysm- moderate size
PAD
Would this be coded as
93458-26, dx 414.00
75625-26, dx 441.4, 443.9
My question is that both aortograms done in DSA with visualization of the iliac and femoral arteries?
Thank you!
Pre-Procedure Diagnosis: Claudication, HTN, abdominal aortic aneurysm
Post-Procedure Diagnosis: Nonobstructive CAD, abdominal aortic aneurysm, nonobstructive diffuse femoral disease
Procedure performed: Selective coronary angiogram of the left main (LM) and right coronary artery (RCA). A left ventriculogram was not performed, LHC. Proximal abdominal Aortogram, distal abdominal aortogram - Both aortograms done in DSA with visualization of the iliac and femoral arteries
Anesthesia Used: IV versed and fentanyl, local 2% lidocaine
Blood Loss: 30 mL
Condition: stable
IV Contrast Used: 160 mL
Complications: none
Procedure and Findings in Detail: The procedure was described to the patient including benefits, risks, and alternatives to the procedure. The patient confirmed understanding. The patient signed the informed consent. He was brought into the cath lab. The bilateral groins were prepped in a sterile fashion, and a sterile drape was placed over the patient.
The right common femoral artery (CFA) was palpated and the region above the artery was anesthetized with 2% local lidocaine. A Cook needle was used to access the right CFA. The wire was visualized under fluoroscopy ascending into the common iliac artery. A 6 French sheath was placed over the wire without difficulty in the normal form and fashion. We also gained accesses to the CFV using a cook needle and a modified Seldinger technique and a 4 french sheath.
A 6 Fr diagnostic JL4 was placed in the ascending aorta directed by a J wire. The J wire was removed, the catheter aspirated to remove any air and flushed with normal saline. The diagnostic catheter engaged the left main without difficulty. The diagnostic evaluation revealed the following:
Left main: short no disease
LAD: no occlusive disease
Diagonals: 50% proximal disease
Circumflex: no occlusive disease
Obtuse marginals: 1 small OM
The diagnostic catheter used for the left coronary was removed from the descending aorta over the J wire. A 6 Ft diagnostic JR4 was placed over the wire and guided to the ascending aorta. The J wire was removed. The catheter was aspirated and flushed with normal saline. The diagnostic evaluation revealed the following:
RCA: proximal plaque, 50% mid RCA - right dom
PDA: no obstructive disease
PLV: no obstructive disease
The RCA catheter was removed from the descending aorta over a J wire. We then advanced a 6french pigtail into the LV to complete the left heart cath and obtain LV pressures and pull back gradient.
LVA: not done
LVEDP 4-20
AO 134/61
No pull back gradient
We then removed the pigtail catheter over a J wire and advanced a marker pigtail catheter into the abdominal aorta to the level of the renal arteries. We then removed the J wire and after flushing did a power injection of the proximal aorta from the renals to the iliacs. We then brought the pigtail catheter to the aortoiliac bifurcation and again under DSA did a study of the distal aorta, iliacs and femorals.
Abdominal aortogram:
Patent single renal arteries, normal
Moderate size aneurysm
Diffuse arthrosclerotic disease of iliacs
Ulcerated lesion right iliac 50% stenosis
Femoral diffuse arthrosclerosis
The marker pigtail was then removed over a J wire.
The patient was in hemodynamically stable condition throughout entirety of the procedure. The sheaths were removed and manual pressure was held for 20 mins and application of a Dstat patch. The patient will be on bed rest for 4 hours. He was given a 500cc infusion for reno protection and 1 dose of diamox at DC.
Summary:
Nonobstructive CAD
Abdominal aortic aneurysm- moderate size
PAD
Would this be coded as
93458-26, dx 414.00
75625-26, dx 441.4, 443.9
My question is that both aortograms done in DSA with visualization of the iliac and femoral arteries?
Thank you!