BonnieJ123
Networker
Any help appreciated please. I coded first as lt hc 93458,26 but 93568,93573 need a primary cpt code. Then after much research I began to think maybe code as a rt/lt hc 93460,26 without 93568 or 93573. Please see report below. Thank you
Pre-operative Diagnosis:
cardiac arrest
Post-operative Diagnosis:
1. Cardiogenic shock
Procedure Performed:
1. Bilateral selective coronary angiography
2. Left heart catheterization
3. Radiographic supervision and interpretation of pulmonary angiogram
4. Selective catheter placement in the pulmonary trunk
5. ACLS protocol
6. selective cathter placement in the IVC
Anesthesia Type: Local
Estimated Blood Loss: Minimal
Complications:
None
Procedure Description:
The patient was brought emergently to Cath Lab and prepped and draped in the usual manner.The right common femoral artery was visualized with ultrasound and accessed with a microneedle. A 6 French Arrow sheath was placed. Selective angiography was obtained to the right coronary system with a JR4 diagnostic catheter. Left heart catheterization was performed with a JR4 diagnostic catheter. A JL 3 5 diagnostic catheter was selective angiography left coronary system. The right common femoral vein was isolated with ultrasound and accessed with a microneedle and a microsheath was placed and this was upsized to 11 French sheath. An imaging pigtail catheter was advanced and placed in the inferior vena cava just below the right atrium. Angiogram was performed there was marked reflux of contrast into the superior vena cava and subclavian system. There is significant RV enlargement and RV dysfunction. Utilizing an 03 5 x 260 advantage glide wire was advanced in the left pulmonary artery and the pigtail catheter advanced into the pulmonary trunk. Pulmonary angio was performed at this level as well confirming the absence of significant pulmonary emboli. This concluded the procedure both sheath remained in place.
Findings:Aortic opening pressure: 40/20. Left ventricular systolic pressure was 50 left ventricular end-diastolic pressure was 12
Coronary anatomy:
Left main: Is short and patent
LAD: Free of any significant obstructive CAD
Circumflex/OM: Widely patent and free of any significant CAD
RCA: Large, dominant, widely patent
Inferior venacavogram: The right atrium is dilated there is reflux of contrast into the superior vena cava as well as the brachiocephalic and subclavian veins. The right ventricle is dilated with severe hypokinesis the pulmonary trunk is free of any significant emboli the right and left main pulmonary artery are free of any significant emboli the secondary branches appear to be free of any significant emboli.
Pulmonary angiogram: Again the pulmonary trunk is free of emboli the right and left main pulmonary arteries are free of any significant emboli the proximal secondary branches appear to be free of any emboli.
Impression:
1 cardiogenic shock secondary to severe RV dysfunction
Recommendations:
1. On echocardiogram the left ventricle is underfilled the cavity is very small the right ventricle is severely dilated and severely hypokinetic. This is in line with severe RV dysfunction whether this has worsened as result of the patient's resuscitative efforts or if this is primary cause I am no idea. She does not appear to have had an RV infarct I do not see a pulmonary embolism and there is not any pericardial effusion cannot adequately explain her RV dysfunction at least in an acute manner. I think the overall mortality is extremely high. We have been giving her a fair amount of volume she needs volume. Mechanical support device would have to be an RV support device we certainly do not have that capability here.
Pre-operative Diagnosis:
cardiac arrest
Post-operative Diagnosis:
1. Cardiogenic shock
Procedure Performed:
1. Bilateral selective coronary angiography
2. Left heart catheterization
3. Radiographic supervision and interpretation of pulmonary angiogram
4. Selective catheter placement in the pulmonary trunk
5. ACLS protocol
6. selective cathter placement in the IVC
Anesthesia Type: Local
Estimated Blood Loss: Minimal
Complications:
None
Procedure Description:
The patient was brought emergently to Cath Lab and prepped and draped in the usual manner.The right common femoral artery was visualized with ultrasound and accessed with a microneedle. A 6 French Arrow sheath was placed. Selective angiography was obtained to the right coronary system with a JR4 diagnostic catheter. Left heart catheterization was performed with a JR4 diagnostic catheter. A JL 3 5 diagnostic catheter was selective angiography left coronary system. The right common femoral vein was isolated with ultrasound and accessed with a microneedle and a microsheath was placed and this was upsized to 11 French sheath. An imaging pigtail catheter was advanced and placed in the inferior vena cava just below the right atrium. Angiogram was performed there was marked reflux of contrast into the superior vena cava and subclavian system. There is significant RV enlargement and RV dysfunction. Utilizing an 03 5 x 260 advantage glide wire was advanced in the left pulmonary artery and the pigtail catheter advanced into the pulmonary trunk. Pulmonary angio was performed at this level as well confirming the absence of significant pulmonary emboli. This concluded the procedure both sheath remained in place.
Findings:Aortic opening pressure: 40/20. Left ventricular systolic pressure was 50 left ventricular end-diastolic pressure was 12
Coronary anatomy:
Left main: Is short and patent
LAD: Free of any significant obstructive CAD
Circumflex/OM: Widely patent and free of any significant CAD
RCA: Large, dominant, widely patent
Inferior venacavogram: The right atrium is dilated there is reflux of contrast into the superior vena cava as well as the brachiocephalic and subclavian veins. The right ventricle is dilated with severe hypokinesis the pulmonary trunk is free of any significant emboli the right and left main pulmonary artery are free of any significant emboli the secondary branches appear to be free of any significant emboli.
Pulmonary angiogram: Again the pulmonary trunk is free of emboli the right and left main pulmonary arteries are free of any significant emboli the proximal secondary branches appear to be free of any emboli.
Impression:
1 cardiogenic shock secondary to severe RV dysfunction
Recommendations:
1. On echocardiogram the left ventricle is underfilled the cavity is very small the right ventricle is severely dilated and severely hypokinetic. This is in line with severe RV dysfunction whether this has worsened as result of the patient's resuscitative efforts or if this is primary cause I am no idea. She does not appear to have had an RV infarct I do not see a pulmonary embolism and there is not any pericardial effusion cannot adequately explain her RV dysfunction at least in an acute manner. I think the overall mortality is extremely high. We have been giving her a fair amount of volume she needs volume. Mechanical support device would have to be an RV support device we certainly do not have that capability here.