csorensen21@yahoo.com
Networker
- Messages
- 70
- Best answers
- 0
I have a cardiac cath case where our physicians performed a left heart cath and attempted to stent the right coronary artery three times but discontinued everytime. They proceeded to follow up with an angioplasty in that right coronary artery instead.
I am under the impression if the PTCA was done prior to the stenting I could code the failed stent attempts, but since it was perfomred after I would code the procedure as
93458-26 heart cath
92920-rc-59 ptca
75658-26-59 upper ext angio
Below is the attached clinical note:
A left heart catherization was done. Right and left coronary angiograms were also done. Guide wire in the radial artery, directed into an accessory vessel parallel to the brachial artery. Wires would go reach the heart, but the catheters will get stuck there, so finally we did an angiogram of the right upper extremity and used a glidewire to direct advance wire across the brachial artery into the heart. Subsequently, we did angiographic images of the right and left coronary artery system and the left ventriculogram.
Then we exchanged the sheath to 6-french sheath over a saftey glidewire. An AR1 guiding catheter was used to engage with the right coronary artery in an attempt to percutaneously intervene on that vessel, which had heavily calcified 75% mid lesion and 50% proximal segment. WE advanced prowater wire without any difficulty. Then, subsequently, we used a 3.0 noncompliant balloon, predialted the lesion. When attmepted to advance a drug eluting stent, the inital stent that we attempted was removed. We attempted another 2.5 x12 stent without success as did the same thing and we had to pull the guide and the wire and the stent as it would not go back into the guiding catheter. Subequently, we attmepted a third stent after exhanging the guides and the wire without success and wihtout the ability to advnace it across the curve in that vessel despite the use of a buddy wire, which is a BMW wire. At that point, we used a 3.5 balloon to predilate the lesion proximal and when we noticed that there is excellent result from the balloon angioplasty taking a 75% to 80% lesion down to 30% to 40% with no evidence of dissection and good flow distally, decision to stop here and montior how she progresses and consider her for rotablator or atheretomy using CSI device. Prior to that , we advanced a 2.0 balloon in the PLV branch that had an 80% lesion down to 20%, maintaing TIMI 3 flow. So, final conclusion was successful PTCA of the RCA at different levels in the mid and the PLV branch without any immediate complications, consideration for rotablator or CSI if there is any further restenosis or recoil in the vessel. Meanwhile, continue to treat the patient with aspirin, PLavix, and beta blockers.
any help would??
I am under the impression if the PTCA was done prior to the stenting I could code the failed stent attempts, but since it was perfomred after I would code the procedure as
93458-26 heart cath
92920-rc-59 ptca
75658-26-59 upper ext angio
Below is the attached clinical note:
A left heart catherization was done. Right and left coronary angiograms were also done. Guide wire in the radial artery, directed into an accessory vessel parallel to the brachial artery. Wires would go reach the heart, but the catheters will get stuck there, so finally we did an angiogram of the right upper extremity and used a glidewire to direct advance wire across the brachial artery into the heart. Subsequently, we did angiographic images of the right and left coronary artery system and the left ventriculogram.
Then we exchanged the sheath to 6-french sheath over a saftey glidewire. An AR1 guiding catheter was used to engage with the right coronary artery in an attempt to percutaneously intervene on that vessel, which had heavily calcified 75% mid lesion and 50% proximal segment. WE advanced prowater wire without any difficulty. Then, subsequently, we used a 3.0 noncompliant balloon, predialted the lesion. When attmepted to advance a drug eluting stent, the inital stent that we attempted was removed. We attempted another 2.5 x12 stent without success as did the same thing and we had to pull the guide and the wire and the stent as it would not go back into the guiding catheter. Subequently, we attmepted a third stent after exhanging the guides and the wire without success and wihtout the ability to advnace it across the curve in that vessel despite the use of a buddy wire, which is a BMW wire. At that point, we used a 3.5 balloon to predilate the lesion proximal and when we noticed that there is excellent result from the balloon angioplasty taking a 75% to 80% lesion down to 30% to 40% with no evidence of dissection and good flow distally, decision to stop here and montior how she progresses and consider her for rotablator or atheretomy using CSI device. Prior to that , we advanced a 2.0 balloon in the PLV branch that had an 80% lesion down to 20%, maintaing TIMI 3 flow. So, final conclusion was successful PTCA of the RCA at different levels in the mid and the PLV branch without any immediate complications, consideration for rotablator or CSI if there is any further restenosis or recoil in the vessel. Meanwhile, continue to treat the patient with aspirin, PLavix, and beta blockers.
any help would??