Wiki Cath Coding Question

Create Wiki
B

Belinda Frisch

Guru
Messages
155
Location
Albany, NY
Best answers
0
One of our interventionalists performed percutaneous coronary intervention to the circumflex (70% stensosis) and marginal branch bifurcation (90% stensosis) with the circumflex dominant artery. How would you code this?
 
Pci

Technique: After informed consent the patient was prepped and draped in a standard fashion. The right groing was anesthetized with Lidocaine. A #7 French sheath and Q4.5 guide were placed in the right groing via Seldinger technique. Angiography revealed a 90% complex marginal branch stenosis and a 70% lesion in the mid circumflex presenting as a bifurcation lesion. We wired the marginal and circumflex with Luge wires. A 3.5 X 24 mm Taxus drug-eluting stent was deployed in the circumflex starting at the marginal branch at 16 atmospheres. We pre-dilated the marginal branch with a 2 mm balloon and then placed a 2.5 X 20 mm Taxus drug-eluting stent at 16 atmospheres in the first marginal branch. There appeared to be mild edge dissection at the proximal portion of the circumflex stent but we had great difficulty delivering balloons and stents to this area. I attempted to place a 3.5 X 12 mm Taxus stent but was unable to. We then dilated sequentially with a 1.5, 2.0, 2.5, and 3.0 and eventially a 3.5 mm balloon and then were able to deliver a 3.5 X 12 mm Driver bare-metal stent to the proximal circumflex, jailing the first marginal branch and overlapping the proximal edge of the initial circumflex stent. There was a 0% residual stenosis in the circumflex at case end with mild 20% narrowing in the proximal portion of the marginal branch. The small caliber ramus branch was not treated. Right groin hemostasis was obtained with a Perclose.

Impression:
Successful PCI to the circumflex and marginal branch bifurcatin with the circumflex dominant artery in a 65-year-old male with 4.5 cm aortic arch aneurysm.

THANKS!
 
Belinda Frisch said:
Technique: After informed consent the patient was prepped and draped in a standard fashion. The right groing was anesthetized with Lidocaine. A #7 French sheath and Q4.5 guide were placed in the right groing via Seldinger technique. Angiography revealed a 90% complex marginal branch stenosis and a 70% lesion in the mid circumflex presenting as a bifurcation lesion. We wired the marginal and circumflex with Luge wires. A 3.5 X 24 mm Taxus drug-eluting stent was deployed in the circumflex starting at the marginal branch at 16 atmospheres. We pre-dilated the marginal branch with a 2 mm balloon and then placed a 2.5 X 20 mm Taxus drug-eluting stent at 16 atmospheres in the first marginal branch. There appeared to be mild edge dissection at the proximal portion of the circumflex stent but we had great difficulty delivering balloons and stents to this area. I attempted to place a 3.5 X 12 mm Taxus stent but was unable to. We then dilated sequentially with a 1.5, 2.0, 2.5, and 3.0 and eventially a 3.5 mm balloon and then were able to deliver a 3.5 X 12 mm Driver bare-metal stent to the proximal circumflex, jailing the first marginal branch and overlapping the proximal edge of the initial circumflex stent. There was a 0% residual stenosis in the circumflex at case end with mild 20% narrowing in the proximal portion of the marginal branch. The small caliber ramus branch was not treated. Right groin hemostasis was obtained with a Perclose.

Impression:
Successful PCI to the circumflex and marginal branch bifurcatin with the circumflex dominant artery in a 65-year-old male with 4.5 cm aortic arch aneurysm.

THANKS!
Click to expand...

I would bill:

92980-LC
93508-26
93545
93556-26,59

Hope that helps :)
 
You must log in or register to reply here.
Top