rconpatton
Contributor
Name of procedure:
LHC
LV angio
Cor. Angio
Selective LIMA
Selective SVG angio
Thrombectomy of occluded vein graft probably to the diagonal and Om Vein graft occluded with thrombus.
Access Site: right femoral artery. 6 french sheath ]used initially and exchanged for a n 8 French sheath because of oozing around the 6 french sheath.
Description of procedure:
The right coronary artery graft occlusion appeared old and there was filling of the RPDA and RPL via right-to-right collaterals. The acute problem was the other vein graft presumably going to the diagonal and OM. This was intubated with a JR 4 guide and the occlusion crossed without any difficulty with an angled PT Choice extra support wire. The Export catheter was then used and multiple passes were made with thrombus retrieval and significantly improved flow with the distal vessel being visualized. However, the very distal end of the graft was noted to have a filling defect and it was not clear where the insertion site of the graft into the native circulation was. there was also layered thrombus present in the lower 3/4 of the graft. To prevent any further distal thrombus embolization (the OM branch already had some thrombus which embolized and occluded the very distal end of the native vessel), it was decided to not proceed with PCI at this point and leave the patient on Intergrilin and bring the patient back to the Cath Lab tomorrow for PCI. No obvious complication occurred. The patient had been given IV Lasix for this elevated procedure. At the end of the procedure the wires, the thrombectomy Export catheter and guide were removed and the sheath sewn into place. The patient left the cardiac cath lab in stable condition.
Okay this is what I came up with 93459 26 XU, 92937 LD
Dr also said she did a bilat renal angio, but in the report I don't see any result of readings for such.
Here is where I'm confused with codes 92941 & 92937, pt dx (410.80). I chose code 92937.
Dr. came back next day on same pt.
Procedures performed:
SVG angio
PTCA with stent placement of high grade defect in the distal vein graft as well as PTCA via the vein graft of the ostium immediately below the insertion site of the graft with a 2.5 mm balloon
Stent Placement of the distal vein graft with a 3.0 x 9 mm stent inflated to 3.4 mm
Access site: Right femoral artery. The previously placed sheath exchanged for an 8 French Sheath
Description of Procedure:
After the 8 french sheaths were exchanged, a 6 french LCB guide was used to intubate the vein graft to the diagonal--OM. Angiography revealed a filling defect at the distal end of the graft. An angled PT choice extra support wire was used to cross this and placed in the larger vessel which was the obtuse marginal vessel. Both vessels were visualized and were filling well today. after overnight Integrilin infusion and thrombectomy yesterday. Angioplasty was initially performed with a 2.5 mm balloon across the anastomotic site with the very distal end of the balloon sitting in the proximal OM. There was a big mismatch with the size of the graft versus the size of the Obtuse marginal vessel and it was decided to proceed with a stent placed in the very distal vein graft since angioplasty results into the ostium of the OM were very good. Bare-metal stent was deployed at the filling defect site with good results and no residual stenosis. the guide, stent balloon and wire were removed and sheath sewn into place. the patient left the Cardiac Cath lab in stable condition.
This is where my mind got jumbled up,but I came up with 92937 LD. Not sure how medicare will respond to this I might have to send report, and I'm confused on the SVG angio, I'm confused on the angiogram.
Thanks for all the help in advance,
LHC
LV angio
Cor. Angio
Selective LIMA
Selective SVG angio
Thrombectomy of occluded vein graft probably to the diagonal and Om Vein graft occluded with thrombus.
Access Site: right femoral artery. 6 french sheath ]used initially and exchanged for a n 8 French sheath because of oozing around the 6 french sheath.
Description of procedure:
The right coronary artery graft occlusion appeared old and there was filling of the RPDA and RPL via right-to-right collaterals. The acute problem was the other vein graft presumably going to the diagonal and OM. This was intubated with a JR 4 guide and the occlusion crossed without any difficulty with an angled PT Choice extra support wire. The Export catheter was then used and multiple passes were made with thrombus retrieval and significantly improved flow with the distal vessel being visualized. However, the very distal end of the graft was noted to have a filling defect and it was not clear where the insertion site of the graft into the native circulation was. there was also layered thrombus present in the lower 3/4 of the graft. To prevent any further distal thrombus embolization (the OM branch already had some thrombus which embolized and occluded the very distal end of the native vessel), it was decided to not proceed with PCI at this point and leave the patient on Intergrilin and bring the patient back to the Cath Lab tomorrow for PCI. No obvious complication occurred. The patient had been given IV Lasix for this elevated procedure. At the end of the procedure the wires, the thrombectomy Export catheter and guide were removed and the sheath sewn into place. The patient left the cardiac cath lab in stable condition.
Okay this is what I came up with 93459 26 XU, 92937 LD
Dr also said she did a bilat renal angio, but in the report I don't see any result of readings for such.
Here is where I'm confused with codes 92941 & 92937, pt dx (410.80). I chose code 92937.
Dr. came back next day on same pt.
Procedures performed:
SVG angio
PTCA with stent placement of high grade defect in the distal vein graft as well as PTCA via the vein graft of the ostium immediately below the insertion site of the graft with a 2.5 mm balloon
Stent Placement of the distal vein graft with a 3.0 x 9 mm stent inflated to 3.4 mm
Access site: Right femoral artery. The previously placed sheath exchanged for an 8 French Sheath
Description of Procedure:
After the 8 french sheaths were exchanged, a 6 french LCB guide was used to intubate the vein graft to the diagonal--OM. Angiography revealed a filling defect at the distal end of the graft. An angled PT choice extra support wire was used to cross this and placed in the larger vessel which was the obtuse marginal vessel. Both vessels were visualized and were filling well today. after overnight Integrilin infusion and thrombectomy yesterday. Angioplasty was initially performed with a 2.5 mm balloon across the anastomotic site with the very distal end of the balloon sitting in the proximal OM. There was a big mismatch with the size of the graft versus the size of the Obtuse marginal vessel and it was decided to proceed with a stent placed in the very distal vein graft since angioplasty results into the ostium of the OM were very good. Bare-metal stent was deployed at the filling defect site with good results and no residual stenosis. the guide, stent balloon and wire were removed and sheath sewn into place. the patient left the Cardiac Cath lab in stable condition.
This is where my mind got jumbled up,but I came up with 92937 LD. Not sure how medicare will respond to this I might have to send report, and I'm confused on the SVG angio, I'm confused on the angiogram.
Thanks for all the help in advance,
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