Prepare for the CIRCC® Exam

REASON FOR CARDIAC CATHETERIZATION:

1. Angina with abnormal nuclear stress test, inferior myocardial ischemia
2. Significant carotid artery disease on carotid duplex study [recent transient ischemic attack (TIA)]

PROCEDURES PERFORMED:

1. Left heart catheterization
2. Selective coronary angiography
3. Left ventriculography
4. Aortic arch angiography
5. Selective right common carotid angiography
6. Selective left common carotid angiography
7. Bilateral intracerebral angiography

DESCRIPTION OF PROCEDURE:

2% Lidocaine was infiltrated in right groin tissue for anesthesia. 4 French catheter was inserted in the right femoral artery, using single wall technique. Selective coronary angiography and left ventriculography, aortic arch angiography, selective carotid angiography bilaterally, and intracerebral angiography were performed using JL6, JR-4, pigtail catheter. Catheters were placed selectively into the right and left coronary and right and left common carotid arteries. The patient tolerated the procedure well. All wires and catheters were removed. Hemostasis was obtained with manual hold.

RESULTS CORONARY AND CAROTID ANGIOGRAPHY:

1. Left main: Patent, did bifurcate into the left anterior descending artery and left circumflex artery.
2. Left anterior descending artery: There was 40-50% ostial lesion. The rest of the vessel appears to be patent. No obvious disease noted.
3. Left circumflex artery: There was minimal irregularity noted but no significant occlusion seen.
4. Right coronary artery: Large, dominant, there are minimal irregularities but no significant occlusion seen.
5. Left ventriculography was performed in RAO projection which showed diffuse hypokinesia with overall moderate to severe LV systolic dysfunction with estimated left ventricular ejection fraction of about 45%. There was no significant mitral regurgitation noted. Aortic root size however appears to be dilated and including the ascending aorta as well. Left heart pressures were obtained and recorded in the patient log
6. Aortic arch angiography: Showed dilated ascending and transverse portions of the aortic arch indicating the presence of aortic aneurysm. There was no obvious disease in the innominate artery, right and left subclavian arteries, and proximal carotid arteries. There is normal anatomy.
7. Selective right carotid angiography showed minimal irregularity noted but no significant occlusion. The internal carotid artery has about 50% disease in the proximal portion with no significant occlusion. Otherwise the extent of carotid artery was patent. Only minimal irregularity noted. Left carotid angiography showed mild disease about 20% in the mid portion. The internal distal and involving the proximal; portion of the internal carotid artery was 50% lesion. External carotid artery has mild atherosclerosis in the proximal portion. There is no significant occlusion otherwise.
8. Bilateral intracerebral angiography showed no midline shift. No obvious abnormalities noted with normal appearance of cerebral arteries.

Question 1:

The correct heart catheterization codes are:

1. 93458
2. 93459
3. 75625-59, 93458
4. 93460

Question 2:

The correct peripheral codes are:

1. 36224-50
2. 36224-50, 36227
3. 36223-50
4. 36223, 36223-59, 36227

INDICATION:

83-year-old female with right nephroureteral stent catheter in place. Patient presents with acute onset of significant decreased amount of output draining from the right nephroureteral catheter.

PROCEDURE IN DETAIL:

Patient was placed in the prone position. The right nephroureteral stent catheter was prepped and draped in normal sterile fashion.

Injection of the catheter was performed under fluoroscopic imaging, confirming good positioning of the existing nephroureteral stent.

The right nephroureteral catheter was removed over a guidewire. A new 8 French nephroureteral catheter was positioned and locked in place. Confirmation of position was made with injection of radiopaque contrast.

The catheter was sutured in place. Sterile dry dressings were applied to the flank region.

IMPRESSION:

Nephrostogram with exchange of right nephroureteral stent.

Question 3:

Which is (are) the correct code(s)?

1. 50385
2. 50387
3. 50387, 50394, 74425
4. 50394, 50398, 74425, 75984

Question 1: A

Question 2: C

Question 3: B