Can someone please help me code this procedure. Should it be billed with 93510-26, 93545 & 93556-26 only or there should be any other codes..
1. Left heart catheterization.
2. Selective left and right coronary angiography.
3. Supervision and interpretation of coronary angiography.
4. Coronary angiography of the vein bypass graft to the obtuse marginal branch.
5. Coronary angiography of the left internal mammary artery bypass graft to the left anterior descending.
Following informed consent, the patient was brought to the cardiac catheterization laboratory where the right groin was prepped and draped in the usual sterile fashion. Xylocaine 8 mL of 1% was infiltrated into the right groin for local anesthesia. A 6-French sheath was introduced in the right femoral artery using the modified Seldinger technique. A 6-French JL4 and a 6-French JR4 catheter were used for selective left and right coronary angiography respectively. Subsequently, a pigtail catheter was advanced to the left ventricle where pressure measurements were obtained, no cineventriculography was performed in order to save contrast dye. Subsequently, we utilized a 6-French JR4 catheter for coronary angiography of the vein bypass graft to the obtuse marginal branch and left internal mammary artery bypass graft to the LAD. We utilized a multipurpose catheter in addition to search for vein graft to the right coronary artery which was not present.
Subsequently, we removed all catheters and sheaths and manual pressure was applied until very good hemostasis was obtained. There were no complications during the procedure.
CONCLUSION: This is a 71-year-old female patient with angina and non-ST elevation myocardial infarction who was found to have occlusion of the left main artery, a small residual right coronary artery which is likely in conjunction with ischemia in this territory, no evidence of an right coronary artery bypass graft, patent obtuse marginal bypass graft with previous stenting, pre-stent aneurysm, multiple diffuse arteriosclerotic changes with a maximum luminal diameter of 30% to 40%, patent left internal mammary artery bypass graft to the left anterior descending with diffuse arteriosclerotic left anterior descending. All findings were conferred to the patient and to the patient's family.
1. Left heart catheterization.
2. Selective left and right coronary angiography.
3. Supervision and interpretation of coronary angiography.
4. Coronary angiography of the vein bypass graft to the obtuse marginal branch.
5. Coronary angiography of the left internal mammary artery bypass graft to the left anterior descending.
Following informed consent, the patient was brought to the cardiac catheterization laboratory where the right groin was prepped and draped in the usual sterile fashion. Xylocaine 8 mL of 1% was infiltrated into the right groin for local anesthesia. A 6-French sheath was introduced in the right femoral artery using the modified Seldinger technique. A 6-French JL4 and a 6-French JR4 catheter were used for selective left and right coronary angiography respectively. Subsequently, a pigtail catheter was advanced to the left ventricle where pressure measurements were obtained, no cineventriculography was performed in order to save contrast dye. Subsequently, we utilized a 6-French JR4 catheter for coronary angiography of the vein bypass graft to the obtuse marginal branch and left internal mammary artery bypass graft to the LAD. We utilized a multipurpose catheter in addition to search for vein graft to the right coronary artery which was not present.
Subsequently, we removed all catheters and sheaths and manual pressure was applied until very good hemostasis was obtained. There were no complications during the procedure.
CONCLUSION: This is a 71-year-old female patient with angina and non-ST elevation myocardial infarction who was found to have occlusion of the left main artery, a small residual right coronary artery which is likely in conjunction with ischemia in this territory, no evidence of an right coronary artery bypass graft, patent obtuse marginal bypass graft with previous stenting, pre-stent aneurysm, multiple diffuse arteriosclerotic changes with a maximum luminal diameter of 30% to 40%, patent left internal mammary artery bypass graft to the left anterior descending with diffuse arteriosclerotic left anterior descending. All findings were conferred to the patient and to the patient's family.