would there be enough documentation in this note to code a
93461
93567
and can I code the femoral angiogram separate? like 75710. am I missing anything in my coding? also left internal mammary could it also be added 75756.
PROCEDURES: Right heart catheterization, left heart catheterization,
selective coronary angiography, ventriculography, aortic root injection,
left internal mammary artery visualization, saphenous vein graft x3
visualization, Angio-Seal deployment, and right femoral angiogram.
INDICATION FOR PROCEDURE: A female with a history of coronary
artery bypass grafting in 2009. At that time, she received a left internal
mammary artery to the left anterior descending coronary artery, saphenous
vein graft to the OM, saphenous vein graft to diagonal, and saphenous vein
graft to the PDA. She has been complaining of progressive shortness of
breath and exertional chest discomfort very suspicious for angina. She had
an echocardiogram performed, which showed preserved left ventricular
ejection fraction, moderately severe aortic valve stenosis with mild mitral
regurgitation. Cardiac catheterization and coronary angiography are being
performed to hemodynamically support the diagnosis of aortic stenosis and to
assess graft patency.
PROCEDURE NOTE: Using sterile technique with local anesthesia, right
femoral arterial access and venous access were obtained via the Seldinger
technique. Selective coronary angiography, ventriculography, aortic root
angiography were then performed in multiple RAO and LAO projections using 6-
French JL-4, JR-4, JL 4.5, left internal mammary artery, left coronary
bypass, and right coronary bypass catheters. Following the procedure,
hemostasis was achieved with the Angio-Seal method. Patient tolerated the
procedure well without complications.
FINDINGS: Hemodynamics: Please also see flow sheet.
Right atrial pressure was 3, right ventricular systolic pressure 32,
diastolic 4; pulmonary capillary wedge pressure 5; pulmonary artery systolic
pressure 29, diastolic 16; aortic systolic pressure 141, diastolic 68; left
ventricular systolic pressure 180, and aortic pressure 18. Aortic
saturation 95.7, pulmonary artery saturation 70. Cardiac output by Fick was
5.3, cardiac output by thermodilution 5.6. The mean gradient is
approximately 35 mm across the aortic valve. Aortic valve area is
approximately 0.9 cm2.
Selective coronary angiography:
1. Left main coronary artery has a distal stenosis of 50%.
2. The left anterior descending coronary artery is severely occluded. The
distal left anterior descending coronary artery is seen to fill via
collateral flow from the left internal mammary artery. There are
diagonals with diffuse disease.
3. The circumflex coronary artery has a moderately severe proximal diffuse
disease.
4. The right coronary artery has a 90% stenosis at the ostium and a 75%
stenosis in the mid segment.
The saphenous vein graft to the right coronary artery is occluded and seen
as a stump.
The saphenous vein graft to the obtuse marginal is patent with good distal
flow.
Saphenous vein graft to the diagonal is patent with good distal runoff.
The left internal mammary artery to left anterior descending coronary artery
is patent with good distal runoff.
Ventriculography: Ejection fraction is estimated at 55% with mild mitral
regurgitation.
Right femoral angiogram: This revealed a groin stick suitable for Angio-
Seal deployment and Angio-Seal was successfully deployed.
SUMMARY:
1. Occluded vein graft to the right with stenosis in the native right
coronary artery with an ostial stenosis of 90% and midvessel stenosis
70%.
2. Patent vein graft to the obtuse marginal, diagonal, and patent LIMA to
the LAD.
3. Preserved left ventricular ejection fraction.
4. Normal pulmonary systolic pressures.
5. Severe aortic valve stenosis.
RECOMMENDATION: Aortic valve replacement plus bypass of the right coronary
artery
93461
93567
and can I code the femoral angiogram separate? like 75710. am I missing anything in my coding? also left internal mammary could it also be added 75756.
PROCEDURES: Right heart catheterization, left heart catheterization,
selective coronary angiography, ventriculography, aortic root injection,
left internal mammary artery visualization, saphenous vein graft x3
visualization, Angio-Seal deployment, and right femoral angiogram.
INDICATION FOR PROCEDURE: A female with a history of coronary
artery bypass grafting in 2009. At that time, she received a left internal
mammary artery to the left anterior descending coronary artery, saphenous
vein graft to the OM, saphenous vein graft to diagonal, and saphenous vein
graft to the PDA. She has been complaining of progressive shortness of
breath and exertional chest discomfort very suspicious for angina. She had
an echocardiogram performed, which showed preserved left ventricular
ejection fraction, moderately severe aortic valve stenosis with mild mitral
regurgitation. Cardiac catheterization and coronary angiography are being
performed to hemodynamically support the diagnosis of aortic stenosis and to
assess graft patency.
PROCEDURE NOTE: Using sterile technique with local anesthesia, right
femoral arterial access and venous access were obtained via the Seldinger
technique. Selective coronary angiography, ventriculography, aortic root
angiography were then performed in multiple RAO and LAO projections using 6-
French JL-4, JR-4, JL 4.5, left internal mammary artery, left coronary
bypass, and right coronary bypass catheters. Following the procedure,
hemostasis was achieved with the Angio-Seal method. Patient tolerated the
procedure well without complications.
FINDINGS: Hemodynamics: Please also see flow sheet.
Right atrial pressure was 3, right ventricular systolic pressure 32,
diastolic 4; pulmonary capillary wedge pressure 5; pulmonary artery systolic
pressure 29, diastolic 16; aortic systolic pressure 141, diastolic 68; left
ventricular systolic pressure 180, and aortic pressure 18. Aortic
saturation 95.7, pulmonary artery saturation 70. Cardiac output by Fick was
5.3, cardiac output by thermodilution 5.6. The mean gradient is
approximately 35 mm across the aortic valve. Aortic valve area is
approximately 0.9 cm2.
Selective coronary angiography:
1. Left main coronary artery has a distal stenosis of 50%.
2. The left anterior descending coronary artery is severely occluded. The
distal left anterior descending coronary artery is seen to fill via
collateral flow from the left internal mammary artery. There are
diagonals with diffuse disease.
3. The circumflex coronary artery has a moderately severe proximal diffuse
disease.
4. The right coronary artery has a 90% stenosis at the ostium and a 75%
stenosis in the mid segment.
The saphenous vein graft to the right coronary artery is occluded and seen
as a stump.
The saphenous vein graft to the obtuse marginal is patent with good distal
flow.
Saphenous vein graft to the diagonal is patent with good distal runoff.
The left internal mammary artery to left anterior descending coronary artery
is patent with good distal runoff.
Ventriculography: Ejection fraction is estimated at 55% with mild mitral
regurgitation.
Right femoral angiogram: This revealed a groin stick suitable for Angio-
Seal deployment and Angio-Seal was successfully deployed.
SUMMARY:
1. Occluded vein graft to the right with stenosis in the native right
coronary artery with an ostial stenosis of 90% and midvessel stenosis
70%.
2. Patent vein graft to the obtuse marginal, diagonal, and patent LIMA to
the LAD.
3. Preserved left ventricular ejection fraction.
4. Normal pulmonary systolic pressures.
5. Severe aortic valve stenosis.
RECOMMENDATION: Aortic valve replacement plus bypass of the right coronary
artery