Left Heart Cath - radial approach

amym

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Our physician is billing a left heart cath (radial approach). Would this impact my coding of 93458? I know almost all caths are performed through the patients groin!

SUMMARY:

-- CORONARY CIRCULATION:
-- There was 1-vessel coronary artery disease ( 75 % circumflex).

-- CARDIAC STRUCTURES:
-- Global left ventricular function was normal. EF calculated by contrast
ventriculography was 60 %.

PROCEDURES PERFORMED:

-- Left heart catheterization with ventriculography.
-- Right coronary angiography.
-- Left coronary angiography.
-- Hemostasis with TR Band.

RECOMMENDATIONS:
May need OM stent if CP recurrent.

INDICATIONS: Angina/MI: unstable angina.

VENTRICLES: There were no left ventricular global or regional wall motion
abnormalities. Global left ventricular function was normal. EF calculated
by contrast ventriculography was 60 %.

VALVES: AORTIC VALVE: The aortic valve was evaluated by left
ventriculography. The aortic valve appeared to be structurally normal. The
aortic valve leaflets exhibited normal thickness and normal excursion.
There was no aortic stenosis. MITRAL VALVE: The mitral valve was evaluated
by left ventriculography. The mitral valve appeared grossly normal. The
mitral leaflets exhibited normal thickness and normal excursion. The
mitral valve exhibited no regurgitation.

CORONARY VESSELS: The coronary circulation is right dominant. There was
1-vessel coronary artery disease ( 75 % circumflex). Left main: Normal.
LAD: Normal. Circumflex: Angiography showed minor luminal irregularities.
1st obtuse marginal: There was a 75 % stenosis. There was TIMI grade 3
flow through the vessel (brisk flow). RCA: Normal.

PROCEDURE: The risks and alternatives of the procedures and conscious
sedation were explained to the patient and informed consent was obtained.
The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile
fashion.

-- Right radial artery access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a catheter was
advanced over the wire into the vessel.

-- Left heart catheterization. A catheter was advanced to the ascending
aorta. After recording ascending aortic pressure, the catheter was
advanced across the aortic valve and left ventricular pressure was
recorded. Ventriculography was performed using power injection of contrast
agent. Imaging was performed using an RAO projection.

-- Right coronary artery angiography. A catheter was advanced to the
aorta and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.

-- Left coronary artery angiography. A catheter was advanced to the aorta
and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.

-- Hemostasis with TR Band..

COMPLICATIONS:
None occurred during the cath lab visit.
PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
Test started at 14:43. Test concluded at 15:34. RADIATION EXPOSURE:
Fluoroscopy time: 1.4 min.
MEDICATIONS GIVEN:
Midazolam, 1 mg, IV, at 14:43.
Midazolam, 1 mg, IV, at 14:47.
Verapamil (Isoptin, Calan, Covera), 1.25 mcg, intracoronary, at 14:48.
Nitroglycerin, 400 mcg, intracoronary, at 14:48.
Heparin, 3000 units, IA, last dose at 14:49.
1% Lidocaine, 6 ml, subcutaneously, at 14:43.
CONTRAST GIVEN:
Omnipaque 125 ml.

STUDY DIAGRAM

Angiographic findings
Native coronary lesions:
7OM1: Lesion 1: 75 % stenosis.

HEMODYNAMIC TABLES

Pressures: NO PHASE
Pressures: - HR: 79
Pressures: - Rhythm:
Pressures: -- Aortic Pressure (S/D/M): 119/78/98
Pressures: -- Left Ventricle (s/edp): 123/9/--

Outputs: NO PHASE
Outputs: -- CALCULATIONS: Age in years: 54.79
Outputs: -- CALCULATIONS: Body Surface Area: 2.64
Outputs: -- CALCULATIONS: Height in cm: 183.00
Outputs: -- CALCULATIONS: Sex: Male
Outputs: -- CALCULATIONS: Weight in kg: 149.70
 
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