Can anyone please help with coding carotid. Thanks!!!!!
· Procedure Details Patient is a 65-year-old male with recent heart failure reduced ejection fraction was found to have right carotid stenosis. Patient was brought for carotid and cerebral angiography to assess for possible carotid stenting as he would be high risk for CEA. After informed written consent was obtained from the patient which included a discussion of possible risks, possible complications, and alternatives to therapy, she elected to proceed.
The patient was independently monitored under my direct supervision with a qualified registered nursing personnel using automated blood pressure, EKG and pulse oximetry. The detailed conscious record is permanently stored in the hospital information system. The following is the conscious sedation record including start and end times: Meds given [0.5] mg Versed and [25] mcg Fentanyl; Sed start [0901] end [0941], for [40] minutes. There were no complications.
The patient was brought to the cardiac catheterization lab where he was prepped and draped in the usual sterile fashion. Using ultrasound guidance a 5 French micropuncture introducer set was used to obtain access into the right common femoral artery using a modified Seldinger technique in the usual manner without incident. This was exchanged out for a standard 6 French short sheath. Right iliofemoral angiography was then performed. An 035 inch J-tip guidewire was used to advance a pigtail catheter into the ascending aorta. Power injection aortography was performed in an LAO projection. Over the wire the pigtail catheter was removed and a 5 French VTK catheter was inserted over the wire and used to cannulate the left subclavian artery. Digital subtraction angiography was performed. The VTK catheter was then advanced into the left common carotid artery. Carotid angiography was performed in multiple projections followed by left cerebral angiography in a Townes and lateral projections. The VTK catheter was then used to cannulate the right common carotid artery with assistance of the J-tipped wire and carotid angiography was performed in multiple projections. This was followed by right cerebral angiography in a Townes and lateral projections. The VTK catheter was then withdrawn to the aorta. Over the wire all catheters and wires were removed without incident. A Perclose device was used to place hemostasis of the right common femoral arteriotomy and remove the 6 French sheath. The suture broke and manual pressure was applied for excellent hemostasis. Patient tolerated the procedure well and was transferred to PACU in a stable condition. Procedural findings:
Aorta: Type I aortic arch with left common carotid and innominate artery common origin.
Left subclavian artery: Luminal irregularities without critical disease.
Left common carotid artery: Luminal irregularities without critical stenosis.
Left internal carotid artery: 40-50% ostial, calcified stenosis.
Left external carotid artery: Patent without angiographic disease.
Left cerebrals: Patent left ACA and MCA vasculature without critical disease.
Right common carotid artery: Patent without angiographic disease.
Right internal carotid artery: Severe 80-90% ostial stenosis with moderate calcification.
Right external carotid artery: Patent without angiographic disease.
Right cerebrals: Patent MCA and ACA vasculature in the right carotid artery.
Impressions:
1. Type I aortic arch with mild diffuse disease and calcification.
2. Severe Right internal carotid artery stenosis and moderate left carotid artery stenosis.
3. Patent cerebral vasculature without appreciated abnormalities
4. Hemostasis of the right CFA using manual compression after failed Perclose
· Procedure Details Patient is a 65-year-old male with recent heart failure reduced ejection fraction was found to have right carotid stenosis. Patient was brought for carotid and cerebral angiography to assess for possible carotid stenting as he would be high risk for CEA. After informed written consent was obtained from the patient which included a discussion of possible risks, possible complications, and alternatives to therapy, she elected to proceed.
The patient was independently monitored under my direct supervision with a qualified registered nursing personnel using automated blood pressure, EKG and pulse oximetry. The detailed conscious record is permanently stored in the hospital information system. The following is the conscious sedation record including start and end times: Meds given [0.5] mg Versed and [25] mcg Fentanyl; Sed start [0901] end [0941], for [40] minutes. There were no complications.
The patient was brought to the cardiac catheterization lab where he was prepped and draped in the usual sterile fashion. Using ultrasound guidance a 5 French micropuncture introducer set was used to obtain access into the right common femoral artery using a modified Seldinger technique in the usual manner without incident. This was exchanged out for a standard 6 French short sheath. Right iliofemoral angiography was then performed. An 035 inch J-tip guidewire was used to advance a pigtail catheter into the ascending aorta. Power injection aortography was performed in an LAO projection. Over the wire the pigtail catheter was removed and a 5 French VTK catheter was inserted over the wire and used to cannulate the left subclavian artery. Digital subtraction angiography was performed. The VTK catheter was then advanced into the left common carotid artery. Carotid angiography was performed in multiple projections followed by left cerebral angiography in a Townes and lateral projections. The VTK catheter was then used to cannulate the right common carotid artery with assistance of the J-tipped wire and carotid angiography was performed in multiple projections. This was followed by right cerebral angiography in a Townes and lateral projections. The VTK catheter was then withdrawn to the aorta. Over the wire all catheters and wires were removed without incident. A Perclose device was used to place hemostasis of the right common femoral arteriotomy and remove the 6 French sheath. The suture broke and manual pressure was applied for excellent hemostasis. Patient tolerated the procedure well and was transferred to PACU in a stable condition. Procedural findings:
Aorta: Type I aortic arch with left common carotid and innominate artery common origin.
Left subclavian artery: Luminal irregularities without critical disease.
Left common carotid artery: Luminal irregularities without critical stenosis.
Left internal carotid artery: 40-50% ostial, calcified stenosis.
Left external carotid artery: Patent without angiographic disease.
Left cerebrals: Patent left ACA and MCA vasculature without critical disease.
Right common carotid artery: Patent without angiographic disease.
Right internal carotid artery: Severe 80-90% ostial stenosis with moderate calcification.
Right external carotid artery: Patent without angiographic disease.
Right cerebrals: Patent MCA and ACA vasculature in the right carotid artery.
Impressions:
1. Type I aortic arch with mild diffuse disease and calcification.
2. Severe Right internal carotid artery stenosis and moderate left carotid artery stenosis.
3. Patent cerebral vasculature without appreciated abnormalities
4. Hemostasis of the right CFA using manual compression after failed Perclose