Can someone please tell me how to code for the selective right iliofemoral angiogram?
A 73-year-old white male with known coronary artery disease, status post stent in distal RCA, who had
increased frequent episodes of PVCs. Nuclear stress test shows a fixed defect in the inferolateral wall,
suggesting MI or hibernation. Coronary angiogram was performed to evaluate coronary anatomy and to
guide further treatment.
PROCEDURE PERFORMED:
1. Left heart catheterization.
2. LV ventriculogram.
3. Selective right iliofemoral angiogram.
DESCRIPTION OF PROCEDURE:
After informed witnessed and written consent, the patient was given Versed a total of 100 mcg
intravenously. The right coronary artery was engaged using a modified Seldinger technique, after local
anesthesia with 1% lidocaine. Left and right coronary artery were induced using a multipurpose A2
catheter. LV ventriculogram was performed using multipurpose A2 catheter. Selective right iliofemoral
angiogram was also performed. There were no complications. Total fluoroscopy time was 3 minutes.
HEMODYNAMICS:
1. Aortic pressure 135/69, LV pressure 136. There was no pressure gradient across aortic valve.
LVEDP 12.
2. Left main gives rise to LAD and circumflex. Left main is a large caliber vessel that has luminal
irregularities. LAD gives rise to three diagonal branches. LAD has luminal irregularities. Diagonal
branch has nonobstructive coronary artery disease. Left circumflex is slightly ectatic and gives rise to
two OM branches, and has luminal irregularities.
3. RCA is dominant. RCA gives rise to PDA and PLV branch. Proximal RCA has 20% stenosis.
Proximal to mid RCA is ectatic. Mid RCA has 60% eccentric stenosis. The stent in RCA appears to be
patent, with about 20% in-stent stenosis. PLV and PDA branch have luminal irregularities.
4. LV ventriculogram shows LVEF is 65%. No regional wall motion abnormality. No diastolic
dysfunction.
5. Selective right iliofemoral branch showed no atherosclerotic plaque. There appears to be high
bifurcation.
CONCLUSION:
Patent stent in the distal RCA, eccentric 60% stenosis in the mid RCA: Would recommend FFR to evaluate
the hemodynamic significance of this stenosis and to further guide treatment.
A 73-year-old white male with known coronary artery disease, status post stent in distal RCA, who had
increased frequent episodes of PVCs. Nuclear stress test shows a fixed defect in the inferolateral wall,
suggesting MI or hibernation. Coronary angiogram was performed to evaluate coronary anatomy and to
guide further treatment.
PROCEDURE PERFORMED:
1. Left heart catheterization.
2. LV ventriculogram.
3. Selective right iliofemoral angiogram.
DESCRIPTION OF PROCEDURE:
After informed witnessed and written consent, the patient was given Versed a total of 100 mcg
intravenously. The right coronary artery was engaged using a modified Seldinger technique, after local
anesthesia with 1% lidocaine. Left and right coronary artery were induced using a multipurpose A2
catheter. LV ventriculogram was performed using multipurpose A2 catheter. Selective right iliofemoral
angiogram was also performed. There were no complications. Total fluoroscopy time was 3 minutes.
HEMODYNAMICS:
1. Aortic pressure 135/69, LV pressure 136. There was no pressure gradient across aortic valve.
LVEDP 12.
2. Left main gives rise to LAD and circumflex. Left main is a large caliber vessel that has luminal
irregularities. LAD gives rise to three diagonal branches. LAD has luminal irregularities. Diagonal
branch has nonobstructive coronary artery disease. Left circumflex is slightly ectatic and gives rise to
two OM branches, and has luminal irregularities.
3. RCA is dominant. RCA gives rise to PDA and PLV branch. Proximal RCA has 20% stenosis.
Proximal to mid RCA is ectatic. Mid RCA has 60% eccentric stenosis. The stent in RCA appears to be
patent, with about 20% in-stent stenosis. PLV and PDA branch have luminal irregularities.
4. LV ventriculogram shows LVEF is 65%. No regional wall motion abnormality. No diastolic
dysfunction.
5. Selective right iliofemoral branch showed no atherosclerotic plaque. There appears to be high
bifurcation.
CONCLUSION:
Patent stent in the distal RCA, eccentric 60% stenosis in the mid RCA: Would recommend FFR to evaluate
the hemodynamic significance of this stenosis and to further guide treatment.