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WAS WONDERING IF THE CPT CODES 92937, 92938 (FOR ADDTL ARE THE CORRECT CODES FOR THIS?) THANKS SO MUCH!
PROCEDURE: After obtaining informed consent, the patient was
transported in the nonsedated condition to the cardiac
catheterization suite. The patient was prepped and draped in a
sterile fashion. Lidocaine 2% was used to infiltrate the skin and
subcutaneous tissue overlying the right radial artery. A #6
French introducer sheath was placed in the right radial artery
utilizing the modified Seldinger technique and a micropuncture kit
after an Allen's test demonstrated adequate collateral
circulation. We used a #6 French MAC 30/30 to engage the saphenous
vein graft to the posterior descending artery. Angiomax was
administered and I carefully negotiated a run-through wire through
a previously placed stent in the proximal posterior descending
artery that extended into the posterolateral vessel. This was
subtotally occluded at the beginning the procedure. After
crossing the lesion with the wire, I made multiple attempts to
advance a balloon through the subtotally occluded stents,
including a 2.0 Trek balloon and a 1.5 Sprinter balloon. I had
poor guide support from the right radial access site in that my
decision was made to leave that wire in position and the guide
into position and obtained additional arterial access in the right
common femoral artery utilizing the modified Seldinger technique.
I placed a #6 French sheath and used a #6 French multipurpose
guide to engage the same saphenous vein graft. I then passed a
second run-through wire through the vein graft and up the
posterior descending artery and out the posterolateral vessel.
With that second wire in position, I advanced a #6 French guide
liner and the guide deep into the saphenous vein graft to the
yielding adequate support and crossed the occlusion with a 1.5
Sprinter balloon. I performed angioplasty throughout the length of
the subtotally occluded stent and then returned with a two 2.0 x
20 mm balloon and performed high pressure angioplasty within the
stent. After multiple angioplasties, I was able to extend the
guideliner through the stent and then positioned a 3.0 x 18 mm
Xience drug-eluting stent within the previously placed stent at
the proximal segment of the PDA and extending into the
posterolateral vessel. This stent was deployed with several
inflations up to a maximum of 18 atmospheres. After removal of
balloons and wires, we had TIMI-3 flow with no residual stenosis,
no perforation, dissection, or distal embolization. There was
after removal of the guide in the mid segment of the graft, an
area of 60% stenosis that was either a calcified valve or an area
of unstable plaque. The decision was made to cover that lesion
with a 3.5 x 8 mm Xience stent deployed at 12 atmospheres. Final
angiography demonstrated zero residual stenosis, no perforation,
dissection, or distal embolization. Angiography was performed of
the right common femoral artery demonstrating adequate arteriotomy
for use of a closure device. I deployed a second Perclose device
with adequate hemostasis. A TR band was used for radial
hemostasis.
PROCEDURE: After obtaining informed consent, the patient was
transported in the nonsedated condition to the cardiac
catheterization suite. The patient was prepped and draped in a
sterile fashion. Lidocaine 2% was used to infiltrate the skin and
subcutaneous tissue overlying the right radial artery. A #6
French introducer sheath was placed in the right radial artery
utilizing the modified Seldinger technique and a micropuncture kit
after an Allen's test demonstrated adequate collateral
circulation. We used a #6 French MAC 30/30 to engage the saphenous
vein graft to the posterior descending artery. Angiomax was
administered and I carefully negotiated a run-through wire through
a previously placed stent in the proximal posterior descending
artery that extended into the posterolateral vessel. This was
subtotally occluded at the beginning the procedure. After
crossing the lesion with the wire, I made multiple attempts to
advance a balloon through the subtotally occluded stents,
including a 2.0 Trek balloon and a 1.5 Sprinter balloon. I had
poor guide support from the right radial access site in that my
decision was made to leave that wire in position and the guide
into position and obtained additional arterial access in the right
common femoral artery utilizing the modified Seldinger technique.
I placed a #6 French sheath and used a #6 French multipurpose
guide to engage the same saphenous vein graft. I then passed a
second run-through wire through the vein graft and up the
posterior descending artery and out the posterolateral vessel.
With that second wire in position, I advanced a #6 French guide
liner and the guide deep into the saphenous vein graft to the
yielding adequate support and crossed the occlusion with a 1.5
Sprinter balloon. I performed angioplasty throughout the length of
the subtotally occluded stent and then returned with a two 2.0 x
20 mm balloon and performed high pressure angioplasty within the
stent. After multiple angioplasties, I was able to extend the
guideliner through the stent and then positioned a 3.0 x 18 mm
Xience drug-eluting stent within the previously placed stent at
the proximal segment of the PDA and extending into the
posterolateral vessel. This stent was deployed with several
inflations up to a maximum of 18 atmospheres. After removal of
balloons and wires, we had TIMI-3 flow with no residual stenosis,
no perforation, dissection, or distal embolization. There was
after removal of the guide in the mid segment of the graft, an
area of 60% stenosis that was either a calcified valve or an area
of unstable plaque. The decision was made to cover that lesion
with a 3.5 x 8 mm Xience stent deployed at 12 atmospheres. Final
angiography demonstrated zero residual stenosis, no perforation,
dissection, or distal embolization. Angiography was performed of
the right common femoral artery demonstrating adequate arteriotomy
for use of a closure device. I deployed a second Perclose device
with adequate hemostasis. A TR band was used for radial
hemostasis.
