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Coronary Angio - The left commong femoral

amym

Guest
Messages
241
Location
Loganville, GA
Bill 93454 only?

The left commong femoral arter has mild to moderate diffuse plaque. The external iliac artery has narrow 40-50% stenosis in only the visualized portion. The patients superficial femoral artery appeal calcified and also has a 60% stenosis.
Left Main: Moderate-sized vessel with mild to moderate luminal irregularities.
Left anterior descending artery: Moderate-sized vessel. Previously placed proximal and mid stents have moderate, diffuse in-stent restenosis. There is an 80% stenosis at the level of diagonal 1. Diagonal 1 has a 60% ostial stenosis, which is consistent with previous cardiac catherization history of being jailed during pecutaneous intervention. Following the diagonal 1, there is 60-70% stenosis. The remainder of the LAD has moderate, diffuse atherosclerosis.
Left circumflex artery: The left circumflex artery has servere disease. There is a 90% proximal stenosis. There is a 99% stenosis in a previously placed stent. Following this 99% in-stent restenosis, there is evidence of distal flow into the remainder of the left circumflex. Previous images show a large-sized distal vessel to the stenosis with 3-4 obtuse marginal branches. There is a mid vessel OM1 branch that is totally occluded.
The right coronary artery is a small sized vessel. There is a 50% mid LV branch stenosis. The remainder of the vessel has mild to moderate luminal irregularities. It give off a small PDA.
LV-Gram: No significant gradient across the aortic valve. No significant elevated LVEDP, equal 15. Due to equipment malfunction, an LV-Gram was not performed. The patient did receive an echo during the hospitalization, which revealed an ejection fraction of 45-50% moderate inferior wall hypokinesis, negative bubble study.
 
Bill 93454 only?

The left commong femoral arter has mild to moderate diffuse plaque. The external iliac artery has narrow 40-50% stenosis in only the visualized portion. The patients superficial femoral artery appeal calcified and also has a 60% stenosis.
Left Main: Moderate-sized vessel with mild to moderate luminal irregularities.
Left anterior descending artery: Moderate-sized vessel. Previously placed proximal and mid stents have moderate, diffuse in-stent restenosis. There is an 80% stenosis at the level of diagonal 1. Diagonal 1 has a 60% ostial stenosis, which is consistent with previous cardiac catherization history of being jailed during pecutaneous intervention. Following the diagonal 1, there is 60-70% stenosis. The remainder of the LAD has moderate, diffuse atherosclerosis.
Left circumflex artery: The left circumflex artery has servere disease. There is a 90% proximal stenosis. There is a 99% stenosis in a previously placed stent. Following this 99% in-stent restenosis, there is evidence of distal flow into the remainder of the left circumflex. Previous images show a large-sized distal vessel to the stenosis with 3-4 obtuse marginal branches. There is a mid vessel OM1 branch that is totally occluded.
The right coronary artery is a small sized vessel. There is a 50% mid LV branch stenosis. The remainder of the vessel has mild to moderate luminal irregularities. It give off a small PDA.
LV-Gram: No significant gradient across the aortic valve. No significant elevated LVEDP, equal 15. Due to equipment malfunction, an LV-Gram was not performed. The patient did receive an echo during the hospitalization, which revealed an ejection fraction of 45-50% moderate inferior wall hypokinesis, negative bubble study.

You have a 93458 here. Provider appears to have crossed the aortic valve. You don't need to have the LV gram done to bill a 93458 as the LV gram is "when performed".

Jessica CPC, CCC
 
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