bevann0402@bellsouth.net
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this patient had a 93455 on 6/9 (which included the coronary angiography). he returned on 6/30/14 for the following...have narrowed down the codes to use (92920-???, but since he already had a coronary angiography and another one was done on 6/30/14, it was throwing me off a bit.
procedure performed:
1. 6 French sheath placement in right common femoral artery without difficulty
2. coronary angiography
3. PCI, bare metal stent, proximal LAD to salvage a large diagonal artery
4. right common femoral artery angiography
indication chest pain, CAD
pt. underwent 6-french sheath placement in the right common femoral artery without difficulty. coronary angiography was then performed. left main large and long without significant occlusions. the left anterior descending artery has a 70% high proximal to low proximal to early mid 70% lesion, and there is a large diagonal artery past this area, which is not supplied by the IMA to the LAD runoff. the IMA to the LAD is widely patent as known from last cardiac catheterization, but the patient does not have flow into this large diagonal and is compromised because of the severe lesion in the proximal LAD. our decision today is to wire the LAD and to open up the proximal segment to allow more blood supply into the large diagonal.
we placed a 6 French JL 3.5 guide into the ostium of the left main coronary artery. angiomax was started. we wired the LAD utilizing a prowater wire. we pre-dilated the proximal LAD utilizing a 3.0 x 10 mm sprinter. this was 8 atmospheres for 20 seconds, 8 atmospheres for 30 seconds. following this, we took a 3 x 16 veriflex stent, placed it across the predilatated lesion. we took specific views to show that we had no involvement into the ostial left circ, and that we had covered the vessel proximally in its entirety. we then deployed this at 9 atmospheres for 30 seconds. we posted it at 10 atmospheres for 30 seconds. final angiography was performed with and without wire in place. the 70% proximal LAD lesion is now reduced to less than 5% and we are seeing more flow into a large diagonal artery which was the point of the proximal LAD stent. I continued to see competitive flow to the distal LAD so there has been no involvement to the IMA or the distal LAD here. we did do angiography of the right common femoral artery at the close of case. it was appropriate for angio-seal, but he just had angio-seal placed on the 9th and the recommendation would be for manual removal and continued monitoring postconscious sedation overnight.
I appreciate any insight and help.
Beverly
procedure performed:
1. 6 French sheath placement in right common femoral artery without difficulty
2. coronary angiography
3. PCI, bare metal stent, proximal LAD to salvage a large diagonal artery
4. right common femoral artery angiography
indication chest pain, CAD
pt. underwent 6-french sheath placement in the right common femoral artery without difficulty. coronary angiography was then performed. left main large and long without significant occlusions. the left anterior descending artery has a 70% high proximal to low proximal to early mid 70% lesion, and there is a large diagonal artery past this area, which is not supplied by the IMA to the LAD runoff. the IMA to the LAD is widely patent as known from last cardiac catheterization, but the patient does not have flow into this large diagonal and is compromised because of the severe lesion in the proximal LAD. our decision today is to wire the LAD and to open up the proximal segment to allow more blood supply into the large diagonal.
we placed a 6 French JL 3.5 guide into the ostium of the left main coronary artery. angiomax was started. we wired the LAD utilizing a prowater wire. we pre-dilated the proximal LAD utilizing a 3.0 x 10 mm sprinter. this was 8 atmospheres for 20 seconds, 8 atmospheres for 30 seconds. following this, we took a 3 x 16 veriflex stent, placed it across the predilatated lesion. we took specific views to show that we had no involvement into the ostial left circ, and that we had covered the vessel proximally in its entirety. we then deployed this at 9 atmospheres for 30 seconds. we posted it at 10 atmospheres for 30 seconds. final angiography was performed with and without wire in place. the 70% proximal LAD lesion is now reduced to less than 5% and we are seeing more flow into a large diagonal artery which was the point of the proximal LAD stent. I continued to see competitive flow to the distal LAD so there has been no involvement to the IMA or the distal LAD here. we did do angiography of the right common femoral artery at the close of case. it was appropriate for angio-seal, but he just had angio-seal placed on the 9th and the recommendation would be for manual removal and continued monitoring postconscious sedation overnight.
I appreciate any insight and help.
Beverly
