Hello all. I know I have 93453-26 and 93463-26 here but wondering if I should be doing the 93464-26 as well? Provider didn't circle it on the route.
PROCEDURES PERFORMED:
1. Left heart catheterization.
2. Right heart catheterization.
3. Dobutamine and exercise challenge.
PROCEDURE IN DETAIL: After informed consent was obtained and the patient's right groin was prepped and draped in the usual sterile fashion, 30 mL of 1% Lidocaine was introduced in the right groin. The modified Seldinger technique was used to introduce a 6-French sheath in the right common femoral artery and a 7-French in the vein. At the end of the case, manual compression was used for both.
FINDINGS:
Hemodynamics:
Condition 1 (resting):
RA mean pressure of 3, RV pressure 26/7. Pulmonary capillary wedge pressure of 6. PA pressure is 27 with a mean of 14 and LVEDP of 7 with no gradient across the aortic valve.
Saturations: FA saturation 94.6%, PA saturation 67.2%, RA saturation 66%. Fick cardiac output 5.2 liters per minute. Thermodilution cardiac output 6.2 liters per minute.
Condition 2: Dobutamine 10 mcg/kg/min: PA pressure 25/4 with a mean of 12.
Condition 3: Dobutamine 20 mcg/kg/min: PA pressure 26/3 with a mean of 11.
Condition 4: Dobutamine 40 mcg/kg/min: PA pressure 15/1.
Exercise with Dobutamine 40 mcg/kg/min: PA pressure 19/2 with a mean of 9, LVEDP of 4.
7.6 liters per minute.
CONCLUSIONS:
1. Normal resting and exercise pulmonary pressures.
2. Normal left ventricular end-diastolic pressure at rest and with stress.
3. No significant valvular abnormalities noted
Jessica CPC, CCC
PROCEDURES PERFORMED:
1. Left heart catheterization.
2. Right heart catheterization.
3. Dobutamine and exercise challenge.
PROCEDURE IN DETAIL: After informed consent was obtained and the patient's right groin was prepped and draped in the usual sterile fashion, 30 mL of 1% Lidocaine was introduced in the right groin. The modified Seldinger technique was used to introduce a 6-French sheath in the right common femoral artery and a 7-French in the vein. At the end of the case, manual compression was used for both.
FINDINGS:
Hemodynamics:
Condition 1 (resting):
RA mean pressure of 3, RV pressure 26/7. Pulmonary capillary wedge pressure of 6. PA pressure is 27 with a mean of 14 and LVEDP of 7 with no gradient across the aortic valve.
Saturations: FA saturation 94.6%, PA saturation 67.2%, RA saturation 66%. Fick cardiac output 5.2 liters per minute. Thermodilution cardiac output 6.2 liters per minute.
Condition 2: Dobutamine 10 mcg/kg/min: PA pressure 25/4 with a mean of 12.
Condition 3: Dobutamine 20 mcg/kg/min: PA pressure 26/3 with a mean of 11.
Condition 4: Dobutamine 40 mcg/kg/min: PA pressure 15/1.
Exercise with Dobutamine 40 mcg/kg/min: PA pressure 19/2 with a mean of 9, LVEDP of 4.
7.6 liters per minute.
CONCLUSIONS:
1. Normal resting and exercise pulmonary pressures.
2. Normal left ventricular end-diastolic pressure at rest and with stress.
3. No significant valvular abnormalities noted
Jessica CPC, CCC