Hi All,
Please confirm my codes for the below procedure.
93510-26,93543,93555-26,93545,93556-26,75710-26,59,G0269
BLOOD LOSS:
About 15-20 mL.
TOTAL CONTRAST USED:
151 mL.
FLUORO TIME:
12.05 minutes.
COMPLICATIONS:
Nil.
PROCEDURE:
The procedure was done to the right groin. The patient has had 1 mg of
Versed as conscious sedation. Under local anesthesia, right femoral artery
was entered in the first attempt, anterior wall punctured, and 6-French
arterial sheath was put in. The procedure was done without any
anticoagulation. The patient was also given Mucomyst before the procedure
because of mild elevation of serum creatinine level of 1.4.
Using 6-French left coronary catheter, selective left coronary arteriogram
was done in multiple views. This catheter was replaced by 6-FR4 diagnostic
catheter and selective right coronary arteriogram was done in multiple views.
This catheter was replaced with the pigtail catheter and pigtail catheter
was advanced into the left ventricle. It produced multiple PVCs because it
was jumping between the apex and when it is withdrawn it would come out of
the left ventricle. In the process of getting it into the left ventricle
again without wire was made and it crossed the loop into the catheter just
above the sheath. This took quite a bit of time _____ . It seems that the
closed lumen completely. The guidewire of 0.35 was attempted to pass without
any success. Then, I tried _____ again without success. Then, I made
counterclockwise rotation, undid the loop, passed the guidewire, and then
over the wire the pigtail catheter was removed. This was changed to another
pigtail catheter and catheter was again advanced into the left ventricle.
After recording the pressures, the left ventriculogram was done.
Catheter and the wires were removed. Right femoral arteriogram was done.
Angio-Seal was deployed. The patient tolerated the procedure well.
INTERPRETATION:
1. LEFT HEART CARDIAC CATHETERIZATION. THE LV PRESSURE WAS 128/14 AND
DIASTOLIC PRESSURE 19 MMHG. AORTIC PRESSURE GRADIENT WAS 150/28 WITH MEAN OF
85, BUT THIS IS OF COURSE BECAUSE OF OVERSHOOT. THERE WAS NO GRADIENT ACROSS
THE AORTIC VALVE.
2. CORONARY ARTERIOGRAM.
A. LEFT MAIN CORONARY ARTERY 4.25 MM IN DIAMETER, LESS THAN 10% LESION
DISTALLY.
B. LAD HAS A STENT PROXIMALLY. IT IS PATENT. REST OF THE LAD AND ITS D1
BRANCH, WHICH IS 1.75 MM DIAMETER, PATENT. LAD ITSELF IS 3.25 MM IN
DIAMETER.
C. CIRCUMFLEX. THIS ALSO HAS A STENT PROXIMALLY. IT IS A 2.25 TO 2.5 MM
VESSEL. IT GIVES INTO HIGH OM BRANCH, WHICH CAN ALSO BE CONSIDERED AS
INTERMEDIUS. OTHER BRANCHES OM2 AND OM3 ARE PATENT. NO LESIONS.
D. RCA IS A 4 MM VESSEL, HAS A STENT PROXIMALLY. THERE IS NO STENOSIS AND
THERE IS NO LESION IN THE RCA OR ITS BRANCHES LV POSTERIOR BRANCH AND THE PDA
BRANCH. THERE ARE NO COLLATERALS.
3. RIGHT FEMORAL ARTERIOGRAM. THE PUNCTURE IS ABOVE THE BIFURCATION AND
THERE IS NO LESION OR ANY LEAK. THE PATIENT TOLERATED THE PROCEDURE WELL.
CONCLUSIONS:
This is an essentially normal study in terms of having no hemodynamic
lesions. All the stents are patent.
Thanks,
JRC, CPC
Please confirm my codes for the below procedure.
93510-26,93543,93555-26,93545,93556-26,75710-26,59,G0269
BLOOD LOSS:
About 15-20 mL.
TOTAL CONTRAST USED:
151 mL.
FLUORO TIME:
12.05 minutes.
COMPLICATIONS:
Nil.
PROCEDURE:
The procedure was done to the right groin. The patient has had 1 mg of
Versed as conscious sedation. Under local anesthesia, right femoral artery
was entered in the first attempt, anterior wall punctured, and 6-French
arterial sheath was put in. The procedure was done without any
anticoagulation. The patient was also given Mucomyst before the procedure
because of mild elevation of serum creatinine level of 1.4.
Using 6-French left coronary catheter, selective left coronary arteriogram
was done in multiple views. This catheter was replaced by 6-FR4 diagnostic
catheter and selective right coronary arteriogram was done in multiple views.
This catheter was replaced with the pigtail catheter and pigtail catheter
was advanced into the left ventricle. It produced multiple PVCs because it
was jumping between the apex and when it is withdrawn it would come out of
the left ventricle. In the process of getting it into the left ventricle
again without wire was made and it crossed the loop into the catheter just
above the sheath. This took quite a bit of time _____ . It seems that the
closed lumen completely. The guidewire of 0.35 was attempted to pass without
any success. Then, I tried _____ again without success. Then, I made
counterclockwise rotation, undid the loop, passed the guidewire, and then
over the wire the pigtail catheter was removed. This was changed to another
pigtail catheter and catheter was again advanced into the left ventricle.
After recording the pressures, the left ventriculogram was done.
Catheter and the wires were removed. Right femoral arteriogram was done.
Angio-Seal was deployed. The patient tolerated the procedure well.
INTERPRETATION:
1. LEFT HEART CARDIAC CATHETERIZATION. THE LV PRESSURE WAS 128/14 AND
DIASTOLIC PRESSURE 19 MMHG. AORTIC PRESSURE GRADIENT WAS 150/28 WITH MEAN OF
85, BUT THIS IS OF COURSE BECAUSE OF OVERSHOOT. THERE WAS NO GRADIENT ACROSS
THE AORTIC VALVE.
2. CORONARY ARTERIOGRAM.
A. LEFT MAIN CORONARY ARTERY 4.25 MM IN DIAMETER, LESS THAN 10% LESION
DISTALLY.
B. LAD HAS A STENT PROXIMALLY. IT IS PATENT. REST OF THE LAD AND ITS D1
BRANCH, WHICH IS 1.75 MM DIAMETER, PATENT. LAD ITSELF IS 3.25 MM IN
DIAMETER.
C. CIRCUMFLEX. THIS ALSO HAS A STENT PROXIMALLY. IT IS A 2.25 TO 2.5 MM
VESSEL. IT GIVES INTO HIGH OM BRANCH, WHICH CAN ALSO BE CONSIDERED AS
INTERMEDIUS. OTHER BRANCHES OM2 AND OM3 ARE PATENT. NO LESIONS.
D. RCA IS A 4 MM VESSEL, HAS A STENT PROXIMALLY. THERE IS NO STENOSIS AND
THERE IS NO LESION IN THE RCA OR ITS BRANCHES LV POSTERIOR BRANCH AND THE PDA
BRANCH. THERE ARE NO COLLATERALS.
3. RIGHT FEMORAL ARTERIOGRAM. THE PUNCTURE IS ABOVE THE BIFURCATION AND
THERE IS NO LESION OR ANY LEAK. THE PATIENT TOLERATED THE PROCEDURE WELL.
CONCLUSIONS:
This is an essentially normal study in terms of having no hemodynamic
lesions. All the stents are patent.
Thanks,
JRC, CPC
