amym
Guest
I got the cath 93458-26-59 and PCI stent 92928-RC but can I bill for OCT 92132?
SUMMARY:
-- CORONARY CIRCULATION:
-- RCA: There was a 100 % stenosis in the distal third of the vessel
segment. The lesion was was associated with a large filling defect
consistent with thrombus. There was TIMI grade 0 flow through the vessel
(no flow) and a large vascular territory distal to the lesion. This lesion
is a likely culprit for the patient's recent myocardial infarction. It
appears amenable to percutaneous intervention.
-- CARDIAC STRUCTURES:
-- Analysis of regional contractile function demonstrated moderate
anterolateral hypokinesis and severe diaphragmatic hypokinesis.
-- 1ST LESION INTERVENTIONS:
-- A balloon angioplasty was performed on the 100 % lesion in the distal
RCA. Following intervention there was a 0 % residual stenosis.
-- 2ND LESION INTERVENTIONS:
-- A percutaneous intervention was performed on the 50 % lesion in the
distal RCA. Following intervention there was a 0 % residual stenosis.
-- RECOMMENDATIONS:
-- s/p DES RCA X2 2.5x 30 and 2.75x18 postdilated to 3.0
ASA/Plavix
LVEDP 25%
IV diuresis
Stress vs FFR for LAD lesion
PROCEDURES PERFORMED:
-- Left heart catheterization with ventriculography.
-- Left coronary angiography.
-- Right coronary angiography.
-- Hemostasis w/ Angioseal.
-- PTCA.
-- Coronary Drug Eluding Stent Placement.
-- Interventional OCT.
-- Intervention on distal RCA: balloon angioplasty.
-- Intervention on distal RCA: percutaneous intervention.
RECOMMENDATIONS:
s/p DES RCA X2 2.5x 30 and 2.75x18 postdilated to 3.0
ASA/Plavix
LVEDP 25%
IV diuresis
Stress vs FFR for LAD lesion
INDICATIONS: Angina/MI: myocardial infarction without ST elevation
(NSTEMI), CCS class IV. Congestive heart failure with ischemic
cardiomyopathy.
VENTRICLES: Analysis of regional contractile function demonstrated
moderate anterolateral hypokinesis and severe diaphragmatic hypokinesis.
CORONARY VESSELS: Left main: There was a 20 % stenosis at the ostium of
the vessel segment. Proximal LAD: Normal. Mid LAD: There was a tubular 50
% stenosis. Distal LAD: Angiography showed mild atherosclerosis.
Circumflex: The vessel was medium sized. Angiography showed severe
atherosclerosis. 100% occluded dLCX CTO RCA: There was a 100 % stenosis in
the distal third of the vessel segment. The lesion was was associated with
a large filling defect consistent with thrombus. There was TIMI grade 0
flow through the vessel (no flow) and a large vascular territory distal to
the lesion. This lesion is a likely culprit for the patient's recent
myocardial infarction. It appears amenable to percutaneous intervention.
Distal RCA: There was a 50 % stenosis.
PROCEDURE: The risks and alternatives of the procedures and conscious
sedation were explained to the patient and informed consent was obtained.
The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile
fashion.
-- Right femoral artery access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Left heart catheterization. A catheter was advanced to the ascending
aorta. After recording ascending aortic pressure, the catheter was
advanced across the aortic valve and left ventricular pressure was
recorded. Ventriculography was performed using power injection of contrast
agent. Imaging was performed using an RAO projection.
-- Left coronary artery angiography. A catheter was advanced to the aorta
and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Right coronary artery angiography. A catheter was advanced to the
aorta and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Hemostasis w/ Angioseal..
LESION #1 INTERVENTION: A balloon angioplasty was performed on the 100 %
lesion in the distal RCA. Following intervention there was a 0 % residual
stenosis. There was no dissection.
-- Balloon angioplasty was performed, with 1 inflations and a maximum
inflation pressure of 12 atm.
-- A Resolute Integrity Rx 2.50 x 30mm drug-eluting stent was placed
across the lesion and deployed at a maximum inflation pressure of 14 atm.
-- , using a NC Quantum 3.0 x 15 balloon, with 4 inflations and a maximum
inflation pressure of 20 atm.
LESION #2 INTERVENTION: A percutaneous intervention was performed on the
50 % lesion in the distal RCA. Following intervention there was a 0 %
residual stenosis. There was no dissection.
-- A Resolute Integrity Rx 2.75 x 18mm drug-eluting stent was placed
across the lesion and deployed at a maximum inflation pressure of 15 atm.
-- , using a NC Quantum 2.75 x 20 balloon, with 4 inflations and a
maximum inflation pressure of 20 atm.
CARDIAC INTERVENTIONS
-- PTCA.
-- Coronary Drug Eluding Stent Placement.
-- Interventional OCT.
COMPLICATIONS:
There were no adverse outcomes.
None occurred during the cath lab visit.
STUDY DIAGRAM
Angiographic findings
Native coronary lesions:
7Left main: Lesion 1: 20 % stenosis.
7Mid LAD: Lesion 1: tubular, 50 % stenosis.
7RCA: Lesion 1: 100 % stenosis, large vascular territory.
7Distal RCA: Lesion 1: 50 % stenosis.
Intervention results
Native coronary lesions:
7balloon angioplasty of the 100 % stenosis in distal RCA. 0 % residual
stenosis. Stent: Resolute Integrity Rx 2.50 x 30mm drug-eluting.
7percutaneous intervention of the 50 % stenosis in distal RCA. 0 %
residual stenosis. Stent: Resolute Integrity Rx 2.75 x 18mm drug-eluting.
HEMODYNAMIC TABLES
Pressures: Baseline
Pressures: - HR: 88
Pressures: - Rhythm:
Pressures: -- Aortic Pressure (S/D/M): 104/70/85
Pressures: -- Left Ventricle (s/edp): 113/31/--
Outputs: Baseline
Outputs: -- CALCULATIONS: Age in years: 51.64
Outputs: -- CALCULATIONS: Body Surface Area: 1.86
Outputs: -- CALCULATIONS: Height in cm: 160.00
Outputs: -- CALCULATIONS: Sex: Female
SUMMARY:
-- CORONARY CIRCULATION:
-- RCA: There was a 100 % stenosis in the distal third of the vessel
segment. The lesion was was associated with a large filling defect
consistent with thrombus. There was TIMI grade 0 flow through the vessel
(no flow) and a large vascular territory distal to the lesion. This lesion
is a likely culprit for the patient's recent myocardial infarction. It
appears amenable to percutaneous intervention.
-- CARDIAC STRUCTURES:
-- Analysis of regional contractile function demonstrated moderate
anterolateral hypokinesis and severe diaphragmatic hypokinesis.
-- 1ST LESION INTERVENTIONS:
-- A balloon angioplasty was performed on the 100 % lesion in the distal
RCA. Following intervention there was a 0 % residual stenosis.
-- 2ND LESION INTERVENTIONS:
-- A percutaneous intervention was performed on the 50 % lesion in the
distal RCA. Following intervention there was a 0 % residual stenosis.
-- RECOMMENDATIONS:
-- s/p DES RCA X2 2.5x 30 and 2.75x18 postdilated to 3.0
ASA/Plavix
LVEDP 25%
IV diuresis
Stress vs FFR for LAD lesion
PROCEDURES PERFORMED:
-- Left heart catheterization with ventriculography.
-- Left coronary angiography.
-- Right coronary angiography.
-- Hemostasis w/ Angioseal.
-- PTCA.
-- Coronary Drug Eluding Stent Placement.
-- Interventional OCT.
-- Intervention on distal RCA: balloon angioplasty.
-- Intervention on distal RCA: percutaneous intervention.
RECOMMENDATIONS:
s/p DES RCA X2 2.5x 30 and 2.75x18 postdilated to 3.0
ASA/Plavix
LVEDP 25%
IV diuresis
Stress vs FFR for LAD lesion
INDICATIONS: Angina/MI: myocardial infarction without ST elevation
(NSTEMI), CCS class IV. Congestive heart failure with ischemic
cardiomyopathy.
VENTRICLES: Analysis of regional contractile function demonstrated
moderate anterolateral hypokinesis and severe diaphragmatic hypokinesis.
CORONARY VESSELS: Left main: There was a 20 % stenosis at the ostium of
the vessel segment. Proximal LAD: Normal. Mid LAD: There was a tubular 50
% stenosis. Distal LAD: Angiography showed mild atherosclerosis.
Circumflex: The vessel was medium sized. Angiography showed severe
atherosclerosis. 100% occluded dLCX CTO RCA: There was a 100 % stenosis in
the distal third of the vessel segment. The lesion was was associated with
a large filling defect consistent with thrombus. There was TIMI grade 0
flow through the vessel (no flow) and a large vascular territory distal to
the lesion. This lesion is a likely culprit for the patient's recent
myocardial infarction. It appears amenable to percutaneous intervention.
Distal RCA: There was a 50 % stenosis.
PROCEDURE: The risks and alternatives of the procedures and conscious
sedation were explained to the patient and informed consent was obtained.
The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile
fashion.
-- Right femoral artery access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Left heart catheterization. A catheter was advanced to the ascending
aorta. After recording ascending aortic pressure, the catheter was
advanced across the aortic valve and left ventricular pressure was
recorded. Ventriculography was performed using power injection of contrast
agent. Imaging was performed using an RAO projection.
-- Left coronary artery angiography. A catheter was advanced to the aorta
and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Right coronary artery angiography. A catheter was advanced to the
aorta and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Hemostasis w/ Angioseal..
LESION #1 INTERVENTION: A balloon angioplasty was performed on the 100 %
lesion in the distal RCA. Following intervention there was a 0 % residual
stenosis. There was no dissection.
-- Balloon angioplasty was performed, with 1 inflations and a maximum
inflation pressure of 12 atm.
-- A Resolute Integrity Rx 2.50 x 30mm drug-eluting stent was placed
across the lesion and deployed at a maximum inflation pressure of 14 atm.
-- , using a NC Quantum 3.0 x 15 balloon, with 4 inflations and a maximum
inflation pressure of 20 atm.
LESION #2 INTERVENTION: A percutaneous intervention was performed on the
50 % lesion in the distal RCA. Following intervention there was a 0 %
residual stenosis. There was no dissection.
-- A Resolute Integrity Rx 2.75 x 18mm drug-eluting stent was placed
across the lesion and deployed at a maximum inflation pressure of 15 atm.
-- , using a NC Quantum 2.75 x 20 balloon, with 4 inflations and a
maximum inflation pressure of 20 atm.
CARDIAC INTERVENTIONS
-- PTCA.
-- Coronary Drug Eluding Stent Placement.
-- Interventional OCT.
COMPLICATIONS:
There were no adverse outcomes.
None occurred during the cath lab visit.
STUDY DIAGRAM
Angiographic findings
Native coronary lesions:
7Left main: Lesion 1: 20 % stenosis.
7Mid LAD: Lesion 1: tubular, 50 % stenosis.
7RCA: Lesion 1: 100 % stenosis, large vascular territory.
7Distal RCA: Lesion 1: 50 % stenosis.
Intervention results
Native coronary lesions:
7balloon angioplasty of the 100 % stenosis in distal RCA. 0 % residual
stenosis. Stent: Resolute Integrity Rx 2.50 x 30mm drug-eluting.
7percutaneous intervention of the 50 % stenosis in distal RCA. 0 %
residual stenosis. Stent: Resolute Integrity Rx 2.75 x 18mm drug-eluting.
HEMODYNAMIC TABLES
Pressures: Baseline
Pressures: - HR: 88
Pressures: - Rhythm:
Pressures: -- Aortic Pressure (S/D/M): 104/70/85
Pressures: -- Left Ventricle (s/edp): 113/31/--
Outputs: Baseline
Outputs: -- CALCULATIONS: Age in years: 51.64
Outputs: -- CALCULATIONS: Body Surface Area: 1.86
Outputs: -- CALCULATIONS: Height in cm: 160.00
Outputs: -- CALCULATIONS: Sex: Female
