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I coded the following report with 36200, 75625-26, 75716-26, 99152, 99153. Did I code correctly. Also any feed back on the way the report was documented.
Patient continuously monitored by trained personnel and supervised by me throughout sedation.
Sedation Start: 8/26/2022 Time: 12:58 PM
Sedation End: 8/26/2022 Time: 1:34 PM
Total Number of Sedation Minutes: 36
Please refer to nursing documentation for doses of medications administered intravenously as well as the patient’s status during the procedure.
Procedures performed #1 abdominal angiography #2 left lower extremity angiography #3 ultrasound-guided access right femoral artery with micropuncture kit #4 hemostasis by manual compression #5 conscious sedation patient was continuously monitored throughout the procedure note any complications
Patient was brought to the cath lab after IV hydration was begun and oral premedication was given. He was further sedated with fentanyl and midazolam. He was prepped and draped in the usual manner. Angiograms were also done.
Ultrasound-guided access was done. Then a 6 French system was advanced and secured. Very tortuous vessel with very calcified vessels were noted. And utilizing a pigtail and a Wholey wire access to the abdominal aorta was secured angiography was done. We did attempt to cross over to the left side but secondary to kissing iliac stents also it was somewhat difficult. We did utilize even Omni Flush type of catheter also along with the pigtail. Is very difficult to access to the left side from the right side secondary to the stent locations also. No complications were noted. Manual compression was done all the catheter exchanges were made over the wire
Interventions:
None.
After the procedure was completed, sedation was stopped and the sheaths and catheters were all removed. Hemostasis was achieved with manual pressure.
Findings:
#1 abdominal aorta is relatively patent heavily calcified vessel however. Renal arteries are somewhat suboptimally visualized but appears to be patent
#2 left common iliac system and right, iliac systems are patent stents were patent.
#3 right external iliac and left external iliac artery with some mild plaquing with heavily calcified vessels no significant stenosis
4Right common femoral artery about at least moderately significant stenosis proximal to the femoral artery bifurcation in the range of 50 to 60% calcified vessels.
#5 left common iliac system appears to be patent. Tortuous vessel. Profunda system appears to be patent.
#6 left SFA is heavily calcified vessel mid segment is occluded
#7 popliteal artery above the knee where he was reconstituted with a two-vessel runoff with both posterior and anterior tibial artery with plantar arch formation. Moderate disease was noted in the posterior tibial artery but noncritical
Plan the options are somewhat limited. Patient had severely calcified vessels also. The percutaneous intervention may not be the most ideal and given the clinical scenario and also given the anatomical locations heavily calcified vessels. I spoke to vascular surgery with Dr. Ellenby and Dr. Patel also. Discharge of the patient later today after the groin status is stable. Continue current medical management. Outpatient follow-up will be done. Vascular surgery is going to see the patient also. I spoke to Dr. Patel from vascular surgery also.
TechniqueThe patient was brought to the cardiovascular procedural area non-sedated, in the fasting state. It is estimated the patient lost 10mL of blood during the procedure.
The skin of the bilateral groins was clipped, prepped and draped in the usual sterile manner. (If not otherwise specified, skin prep was bilateral.) The skin at the access site was anesthetized. Using a micropuncture needle with ultrasound (SonoSite) the right femoral artery was succesfully accessed in a retrograde fashion over the guidewire, under fluoroscopic guidance using a Sheath Engage 6f 12cm .038. Ultrasound found the vessel was patent. A (Cath Impulse 6f 110cm Pig) catheter was inserted. A (Guidewire Wholey 145cm Mod J Crv .035in Vasc) guidewire was introduced. A catheter was exchanged for a (Cath Flsh Soft-vu 5f 90cm .038) catheter. A catheter was exchanged for a (Cath Impulse 6f 110cm Pig) catheter.
A (Cath Impulse 6f 110cm Pig) catheter was used to non-selectively engage and inject the abdominal aorta, left common iliac and Left comm by power injection. Multiple views were taken.
A (Cath Impulse 6f 110cm Pig) catheter was used to engage and inject the left common iliac, left internal iliac, left external iliac, left common femoral, left superficial femoral, left profunda femoral, left proximal popliteal, left distal popliteal, left tibioperoneal trunk, left peroneal, left anterior tibial and left posterior tibial artery.
A (Cath Impulse 6f 110cm Pig) catheter was used to engage and inject the left proximal popliteal, left distal popliteal, left tibioperoneal trunk, left peroneal, left anterior tibial and left posterior tibial artery.
A (Cath Impulse 6f 110cm Pig) catheter was used to selectively engage and inject the Pedal artery by power injection.
A (Cath Impulse 6f 110cm Pig) catheter was used to selectively engage and inject the left superficial femoral artery by power injection. Catheter removed intact.
Right femoral artery angiogram was performed using a Sheath Engage 6f 12cm .038 by hand injection. The access site was not suitable for closure. The sheath will be removed manually.
Patient continuously monitored by trained personnel and supervised by me throughout sedation.
Sedation Start: 8/26/2022 Time: 12:58 PM
Sedation End: 8/26/2022 Time: 1:34 PM
Total Number of Sedation Minutes: 36
Please refer to nursing documentation for doses of medications administered intravenously as well as the patient’s status during the procedure.
| AORTA BIFEMORAL ANGIOGRAM - CV |
| LOWER EXTREMITY ANGIOGRAM/POSSIBLE PTA - CV |
Procedures performed #1 abdominal angiography #2 left lower extremity angiography #3 ultrasound-guided access right femoral artery with micropuncture kit #4 hemostasis by manual compression #5 conscious sedation patient was continuously monitored throughout the procedure note any complications
Patient was brought to the cath lab after IV hydration was begun and oral premedication was given. He was further sedated with fentanyl and midazolam. He was prepped and draped in the usual manner. Angiograms were also done.
Ultrasound-guided access was done. Then a 6 French system was advanced and secured. Very tortuous vessel with very calcified vessels were noted. And utilizing a pigtail and a Wholey wire access to the abdominal aorta was secured angiography was done. We did attempt to cross over to the left side but secondary to kissing iliac stents also it was somewhat difficult. We did utilize even Omni Flush type of catheter also along with the pigtail. Is very difficult to access to the left side from the right side secondary to the stent locations also. No complications were noted. Manual compression was done all the catheter exchanges were made over the wire
Interventions:
None.
After the procedure was completed, sedation was stopped and the sheaths and catheters were all removed. Hemostasis was achieved with manual pressure.
Findings:
#1 abdominal aorta is relatively patent heavily calcified vessel however. Renal arteries are somewhat suboptimally visualized but appears to be patent
#2 left common iliac system and right, iliac systems are patent stents were patent.
#3 right external iliac and left external iliac artery with some mild plaquing with heavily calcified vessels no significant stenosis
4Right common femoral artery about at least moderately significant stenosis proximal to the femoral artery bifurcation in the range of 50 to 60% calcified vessels.
#5 left common iliac system appears to be patent. Tortuous vessel. Profunda system appears to be patent.
#6 left SFA is heavily calcified vessel mid segment is occluded
#7 popliteal artery above the knee where he was reconstituted with a two-vessel runoff with both posterior and anterior tibial artery with plantar arch formation. Moderate disease was noted in the posterior tibial artery but noncritical
Plan the options are somewhat limited. Patient had severely calcified vessels also. The percutaneous intervention may not be the most ideal and given the clinical scenario and also given the anatomical locations heavily calcified vessels. I spoke to vascular surgery with Dr. Ellenby and Dr. Patel also. Discharge of the patient later today after the groin status is stable. Continue current medical management. Outpatient follow-up will be done. Vascular surgery is going to see the patient also. I spoke to Dr. Patel from vascular surgery also.
TechniqueThe patient was brought to the cardiovascular procedural area non-sedated, in the fasting state. It is estimated the patient lost 10mL of blood during the procedure.
The skin of the bilateral groins was clipped, prepped and draped in the usual sterile manner. (If not otherwise specified, skin prep was bilateral.) The skin at the access site was anesthetized. Using a micropuncture needle with ultrasound (SonoSite) the right femoral artery was succesfully accessed in a retrograde fashion over the guidewire, under fluoroscopic guidance using a Sheath Engage 6f 12cm .038. Ultrasound found the vessel was patent. A (Cath Impulse 6f 110cm Pig) catheter was inserted. A (Guidewire Wholey 145cm Mod J Crv .035in Vasc) guidewire was introduced. A catheter was exchanged for a (Cath Flsh Soft-vu 5f 90cm .038) catheter. A catheter was exchanged for a (Cath Impulse 6f 110cm Pig) catheter.
A (Cath Impulse 6f 110cm Pig) catheter was used to non-selectively engage and inject the abdominal aorta, left common iliac and Left comm by power injection. Multiple views were taken.
A (Cath Impulse 6f 110cm Pig) catheter was used to engage and inject the left common iliac, left internal iliac, left external iliac, left common femoral, left superficial femoral, left profunda femoral, left proximal popliteal, left distal popliteal, left tibioperoneal trunk, left peroneal, left anterior tibial and left posterior tibial artery.
A (Cath Impulse 6f 110cm Pig) catheter was used to engage and inject the left proximal popliteal, left distal popliteal, left tibioperoneal trunk, left peroneal, left anterior tibial and left posterior tibial artery.
A (Cath Impulse 6f 110cm Pig) catheter was used to selectively engage and inject the Pedal artery by power injection.
A (Cath Impulse 6f 110cm Pig) catheter was used to selectively engage and inject the left superficial femoral artery by power injection. Catheter removed intact.
Right femoral artery angiogram was performed using a Sheath Engage 6f 12cm .038 by hand injection. The access site was not suitable for closure. The sheath will be removed manually.