Coronary Cath Plcmnt/Stenting

em2177

Expert
Messages
311
Location
San Gabriel Valley,CA
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0
Need some assistance in coding this report. Thank you. (93455,92980,LC)???

PROCEDURE:
1. Coronary angiography.
2. Coronary graft study with saphenous vein grafts and left
internal mammary.
3. Percutaneous coronary intervention with stenting of the obtuse
marginal saphenous vein graft anastomosis.

DESCRIPTION OF PROCEDURE:
The patient was prepped and draped in the usual fashion and brought
to the cath lab having been premedicated with Xanax and Benadryl.
Using 2% local Xylocaine, the right femoral region was entered and
sheath was placed. A 4 left Judkins, and then subsequently a 5 left
Judkins ______ implants and ultimately a brachial catheter was
brought to the ostia of the left coronary artery. It was basically
subtotally occluded in the left main. This catheter was removed and
replaced with a modified right, which was advanced to the ostia of
the native right which was subtotally occluded just at the ostium.
This was then brought to the saphenous vein graft to the right
coronary artery. Multiple injections visualized graft in various
projections. This was then brought back to the saphenous vein graft
to the obtuse marginal, and several injections visualized in various
projections.

At this juncture, it was elected to proceed with intervention and due
to the 90% lesion at the distal anastomotic site in the obtuse
marginal, and the saphenous vein graft and marginal. Weight adjusted
heparin was given and then a balloon was brought down the wire and
fully inflated. This was then removed and a 3-5 bare metal stent was
placed down into the area of the stenosis and fully inflated up to 14
atmospheres. Angiograms post showed a markedly improved artery with
no significant residual. Catheter was removed and the sheath was
removed and hemostasis was achieved with Perclose. During the
procedure, the patient was given 1 mg of Versed for conscious
sedation.

OVERALL ASSESSMENT:
1. Coronary artery disease and coronary graft disease with
graft showing patent left internal mammary, a patent saphenous
vein graft in the native right coronary artery with a patent stent
in the body of the graft; saphenous vein graft to the circ is
patent with a patent stent proximally, but a 90% lesion in the
distal anastomosis.
2. Native coronary artery is essentially left main essentially
occluded; the native right proximally ostially occluded.
3. Percutaneous coronary intervention with stenting of the
anastomotic site at the 90% lesion with a 3-5 bare metal stent,
and inflated up to 14 atmospheres. Angiograms post showed a
markedly improved area with no significant residual
 

dpeoples

True Blue
Messages
889
Location
Birmingham, Alabama
Best answers
0
Need some assistance in coding this report. Thank you. (93455,92980,LC)???

PROCEDURE:
1. Coronary angiography.
2. Coronary graft study with saphenous vein grafts and left
internal mammary.
3. Percutaneous coronary intervention with stenting of the obtuse
marginal saphenous vein graft anastomosis.

DESCRIPTION OF PROCEDURE:
The patient was prepped and draped in the usual fashion and brought
to the cath lab having been premedicated with Xanax and Benadryl.
Using 2% local Xylocaine, the right femoral region was entered and
sheath was placed. A 4 left Judkins, and then subsequently a 5 left
Judkins ______ implants and ultimately a brachial catheter was
brought to the ostia of the left coronary artery. It was basically
subtotally occluded in the left main. This catheter was removed and
replaced with a modified right, which was advanced to the ostia of
the native right which was subtotally occluded just at the ostium.
This was then brought to the saphenous vein graft to the right
coronary artery. Multiple injections visualized graft in various
projections. This was then brought back to the saphenous vein graft
to the obtuse marginal, and several injections visualized in various
projections.

At this juncture, it was elected to proceed with intervention and due
to the 90% lesion at the distal anastomotic site in the obtuse
marginal, and the saphenous vein graft and marginal. Weight adjusted
heparin was given and then a balloon was brought down the wire and
fully inflated. This was then removed and a 3-5 bare metal stent was
placed down into the area of the stenosis and fully inflated up to 14
atmospheres. Angiograms post showed a markedly improved artery with
no significant residual. Catheter was removed and the sheath was
removed and hemostasis was achieved with Perclose. During the
procedure, the patient was given 1 mg of Versed for conscious
sedation.

OVERALL ASSESSMENT:
1. Coronary artery disease and coronary graft disease with
graft showing patent left internal mammary, a patent saphenous
vein graft in the native right coronary artery with a patent stent
in the body of the graft; saphenous vein graft to the circ is
patent with a patent stent proximally, but a 90% lesion in the
distal anastomosis.
2. Native coronary artery is essentially left main essentially
occluded; the native right proximally ostially occluded.
3. Percutaneous coronary intervention with stenting of the
anastomotic site at the 90% lesion with a 3-5 bare metal stent,
and inflated up to 14 atmospheres. Angiograms post showed a
markedly improved area with no significant residual
I agree with the codes you have chosen.

HTH :)
 
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