I know any angio's done to access the closure site is inclusive to the heart cath, but what about when just a iliofemoral is done with no mention of the closure site. I looked into some notes I have:
From Dr. Z's Webiner July, 2011 "angiography for closure device placement and the actual closure device placement are inclusive"
From Dr. Z's Diagnostic and Intervention Cardiovascular coding Reference:
"If non-selective ileofemoral angiography is performed at the time of a cardiac catheterization either form the sheath or a catheter in the abdominal aorta, use G0278"
So my question is, does this procedure constitute use of G0278? ( Just need help with Iliofemoral angio, no the whole report. Thanks!
TITLE: Left heart catheterization, left ventriculogram via selective
injection, selective coronary arteriography, left and right. Iliofemoral
angiography, right and Angio-Seal closure.
TECHNIQUE: Following preparation of the right groin, the right femoral artery
was entered. A 6-French sheath placed, 6-French pigtail catheter was placed
in the left ventricle via retrograde fashion and left ventriculography
performed in the RAO and LAO projections. Catheter was exchanged for an R4
catheter, 6-French and right coronary arteriography performed. Catheter was
exchanged for a left 4 Judkins catheter. Left coronary arteriography
performed in multiple projections and iliofemoral angiography was performed
via the sheath. There was no immediate complication.
FINDINGS:
Hemodynamics: Left ventricular end-diastolic pressure was 22. There was no
systolic gradient across the aortic valve.
Angiography: Left ventriculography regional wall motion shows the inferior
wall to be normally. The proximal anterior wall is hypokinetic. The distal
anterior wall is severely hypokinetic and the inferoapical a localized segment
is dyskinetic on the LAO projection, the posterior wall is normal and the
septum is hypokinetic. Overall, left ventricular ejection fraction estimated
at 40-45%.
The right coronary artery is stented from the ostium to the mid vessel. The
right coronary artery shows an ostial greater than 80% stenosis and then there
is diffuse in-stent restenosis throughout much of the length of the stented
portion of the vessel. After the large first marginal branch the vessel is
totally occluded in stented area. There is distal filling of the artery via
left-to-right collateral blood flow.
The left main coronary has no high-grade stenosis. The left anterior
descending in its stented portion shows no high-grade stenosis. There is a
subtotal occlusion of the origin of the second and third diagonals, which was
seen on previous angiography.
There has been progressive disease in the proximal segment of the obtuse
marginal branch with now eccentric 80% stenosis involving the main branch and
then a subtotal stenosis involving the ostium of the upper branch of this
marginal (bifurcation lesion).
Impression of the right iliofemoral angiogram shows no significant stenosis in
the iliac or femoral artery.
IMPRESSION:
1. Prior apical myocardial infarction with reduced left ventricular ejection
fraction to 40-45%.
2. Mildly elevated left ventricular end-diastolic pressure.
3. Multivessel coronary artery disease with interval occlusion of the right
coronary artery with additional diffuse in-stent restenosis.
4. No in-stent restenosis in the left anterior descending.
5. Progressive disease in the circumflex marginal.
From Dr. Z's Webiner July, 2011 "angiography for closure device placement and the actual closure device placement are inclusive"
From Dr. Z's Diagnostic and Intervention Cardiovascular coding Reference:
"If non-selective ileofemoral angiography is performed at the time of a cardiac catheterization either form the sheath or a catheter in the abdominal aorta, use G0278"
So my question is, does this procedure constitute use of G0278? ( Just need help with Iliofemoral angio, no the whole report. Thanks!
TITLE: Left heart catheterization, left ventriculogram via selective
injection, selective coronary arteriography, left and right. Iliofemoral
angiography, right and Angio-Seal closure.
TECHNIQUE: Following preparation of the right groin, the right femoral artery
was entered. A 6-French sheath placed, 6-French pigtail catheter was placed
in the left ventricle via retrograde fashion and left ventriculography
performed in the RAO and LAO projections. Catheter was exchanged for an R4
catheter, 6-French and right coronary arteriography performed. Catheter was
exchanged for a left 4 Judkins catheter. Left coronary arteriography
performed in multiple projections and iliofemoral angiography was performed
via the sheath. There was no immediate complication.
FINDINGS:
Hemodynamics: Left ventricular end-diastolic pressure was 22. There was no
systolic gradient across the aortic valve.
Angiography: Left ventriculography regional wall motion shows the inferior
wall to be normally. The proximal anterior wall is hypokinetic. The distal
anterior wall is severely hypokinetic and the inferoapical a localized segment
is dyskinetic on the LAO projection, the posterior wall is normal and the
septum is hypokinetic. Overall, left ventricular ejection fraction estimated
at 40-45%.
The right coronary artery is stented from the ostium to the mid vessel. The
right coronary artery shows an ostial greater than 80% stenosis and then there
is diffuse in-stent restenosis throughout much of the length of the stented
portion of the vessel. After the large first marginal branch the vessel is
totally occluded in stented area. There is distal filling of the artery via
left-to-right collateral blood flow.
The left main coronary has no high-grade stenosis. The left anterior
descending in its stented portion shows no high-grade stenosis. There is a
subtotal occlusion of the origin of the second and third diagonals, which was
seen on previous angiography.
There has been progressive disease in the proximal segment of the obtuse
marginal branch with now eccentric 80% stenosis involving the main branch and
then a subtotal stenosis involving the ostium of the upper branch of this
marginal (bifurcation lesion).
Impression of the right iliofemoral angiogram shows no significant stenosis in
the iliac or femoral artery.
IMPRESSION:
1. Prior apical myocardial infarction with reduced left ventricular ejection
fraction to 40-45%.
2. Mildly elevated left ventricular end-diastolic pressure.
3. Multivessel coronary artery disease with interval occlusion of the right
coronary artery with additional diffuse in-stent restenosis.
4. No in-stent restenosis in the left anterior descending.
5. Progressive disease in the circumflex marginal.