Wiki 93464-26

Jess1125

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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
 
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

No 93464, since there is no real documentation of exercis. How was the exercise performed?
HTH,
Jim Pawloski, CIRCC
 
No 93464, since there is no real documentation of exercis. How was the exercise performed?
HTH,
Jim Pawloski, CIRCC

Thanks Jim. Yes it does. That part bothered me that arm ergometry, etc, wasn't mentioned but I didn't like the word "exercise" in there either and wanted to ask as I don't see that done a lot...

Jessica CPC, CCC
 
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