mcauffman86
Networker
Not sure what codes to use here for this report specifically the descending aortography. I am thinking 93458-26, 75625-26,59. Would I code the cath placement 36200 for the aortography as well?
Procedure Ordered:
Procedure(s):
Left Heart Cath W/ Poss Intervention
Indications:
Patient referred for left heart catheterization because of indeterminate atypical chest pain and abnormal stress test
Procedure Performed:
1. Fluoroscopy of the left precordial area
2. Placement of the sheath in right radial artery
3. Left ventriculography
4. Selective right and left coronary artery angiography
5. Descending aortography
Pre-Procedure Diagnosis:
chest pain abn stress test
Atypical angina (HCC)
Abnormal nuclear stress test
Post-Procedure Diagnosis:
No obstructive epicardial coronary artery disease
Case Classification:
Elective/Scheduled
Stress or Imaging Test Performed:
Reported abnormal stress test
Anginal Class:
Indeterminate
Anti-Anginal Meds:
See history and physical
FluoroTime and Dose:
Radiation Tracking
Moderate Sedation:
Moderate sedation was administered using IV Versed and Fentanyl. Patient received continuous EKG, hemodynamic and oximetry monitoring with physician being present for the entire time. Total moderate sedation duration = 20 min.
Estimated Blood Loss:
Minimal
Complications:
No Complications were logged
Procedure Technique:
Left heart catheterization and coronary angiography was performed via right radial artery. Radial artery was punctured with microneedle and 6 F sheath was placed in radial artery. Cocktail of 5000 units of Heparin, 200 microgram of Nitroglycerine and 2.5 mg of Verapamil given through the SidePort of sheath. Hemodynamic recordings were made in the ascending aorta at rest. Selective coronary angiography was performed with injections of Isovue in both RAO and LAO projections at various degrees of obliquity, using a 5 French dexterity Judkins right and Judkins left diagnostic catheter. A 5 French Judkins right diagnostic catheter was then advanced to the ascending aorta and subsequently to the left ventricle where hemodynamic recordings were obtained. Contrast left ventriculography was then performed at 30 degree RAO using 20 mL of Isovue delivered with a power injector. A pullback hemodynamic recording was then made from LV to AO. The catheter was then withdrawn and TR band was applied to the right wrist. Good hemostasis was obtained. The patient tolerated the procedure well and left the laboratory in satisfactory condition. A pigtail catheter 5 French was passed over the wire seated in the descending aorta and aortography with bilateral common iliac artery angiography was performed abdominal visceral artery were visualized
Contrast:
* No intraprocedure medications in log *
Hemodynamic Data:
Aortic pressure was: 2/13/2023 2/13/2023 2/13/2023
AO Systolic Pressure 121 121 145
AO Diastolic Pressure 82 77 82
AO Mean Pressure 104 89 110
LV pressure and LVEDP was: 2/13/2023
LV Systolic Pressure 100
LV Diastolic Pressure 14
LV End Diastolic Pressure 16
Some recent data might be hidden
There was no gradient between the left ventricle and aorta. Fluoroscopy shows below my minimal calcification was noted descending aorta severely calcified. Ascending and also shows
Angiographic Data:
Right coronary artery arises from the right sinus of Valsalva it is a dominant vessel and some by bifurcating into posterior descending artery posterolateral ventricular branch no obstructive disease was noted and its course or its branches
Left main artery arises from the left sinus of Valsalva medium-size vessel with no obstructive disease
Left anterior descending artery arises from the left main artery runs in the interventricular groove some plaque irregularities noted numerous small it is size diagonal branches and numerous septal branches were noted mid to distal segment has got tubular 20-30% lesion but no significant obstructive disease was seen.
Left circumflex artery arises from the left main artery runs in the interventricular groove gives rise to large-sized 1st obtuse marginal branch then continues in AV groove branch some plaque irregularities noted throughout its course but no significant obstructive disease was noted
Left ventriculogram performed in 30 degree RAO projection LVEDP 16 mm of mercury with no regional wall motion abnormality normal function ejection fraction is 65-70%
Descending aortography was performed in AP projection. There is a calcification and the mid segment of the descending aorta infrarenal shows some constriction but no significant obstructive disease was noted there was no aneurysm noted. Celiac trunk was seen with hepatic and splenic vessels were noted with no stenosis. Bilateral renal artery were noted some calcification no significant stenosis is noted superior mesenteric artery does not show any stenosis arises posteriorly from the aorta and bilateral common iliac artery shows some ectatic segments and some dilatation specially of the left common iliac artery with no stenosis
Final Diagnosis:
1. Atherosclerotic heart disease luminal irregularity of the coronary artery but no obstructive disease.
2. Normal left ventricular systolic function
3. Calcified descending aorta with no infrarenal abdominal aortic aneurysm. Celiac trunk asymmetric bilateral renal artery does show any stenosis bilateral common iliac artery does show any stenosis
Procedure Ordered:
Procedure(s):
Left Heart Cath W/ Poss Intervention
Indications:
Patient referred for left heart catheterization because of indeterminate atypical chest pain and abnormal stress test
Procedure Performed:
1. Fluoroscopy of the left precordial area
2. Placement of the sheath in right radial artery
3. Left ventriculography
4. Selective right and left coronary artery angiography
5. Descending aortography
Pre-Procedure Diagnosis:
chest pain abn stress test
Atypical angina (HCC)
Abnormal nuclear stress test
Post-Procedure Diagnosis:
No obstructive epicardial coronary artery disease
Case Classification:
Elective/Scheduled
Stress or Imaging Test Performed:
Reported abnormal stress test
Anginal Class:
Indeterminate
Anti-Anginal Meds:
See history and physical
FluoroTime and Dose:
Radiation Tracking
Moderate Sedation:
Moderate sedation was administered using IV Versed and Fentanyl. Patient received continuous EKG, hemodynamic and oximetry monitoring with physician being present for the entire time. Total moderate sedation duration = 20 min.
Estimated Blood Loss:
Minimal
Complications:
No Complications were logged
Procedure Technique:
Left heart catheterization and coronary angiography was performed via right radial artery. Radial artery was punctured with microneedle and 6 F sheath was placed in radial artery. Cocktail of 5000 units of Heparin, 200 microgram of Nitroglycerine and 2.5 mg of Verapamil given through the SidePort of sheath. Hemodynamic recordings were made in the ascending aorta at rest. Selective coronary angiography was performed with injections of Isovue in both RAO and LAO projections at various degrees of obliquity, using a 5 French dexterity Judkins right and Judkins left diagnostic catheter. A 5 French Judkins right diagnostic catheter was then advanced to the ascending aorta and subsequently to the left ventricle where hemodynamic recordings were obtained. Contrast left ventriculography was then performed at 30 degree RAO using 20 mL of Isovue delivered with a power injector. A pullback hemodynamic recording was then made from LV to AO. The catheter was then withdrawn and TR band was applied to the right wrist. Good hemostasis was obtained. The patient tolerated the procedure well and left the laboratory in satisfactory condition. A pigtail catheter 5 French was passed over the wire seated in the descending aorta and aortography with bilateral common iliac artery angiography was performed abdominal visceral artery were visualized
Contrast:
* No intraprocedure medications in log *
Hemodynamic Data:
Aortic pressure was: 2/13/2023 2/13/2023 2/13/2023
AO Systolic Pressure 121 121 145
AO Diastolic Pressure 82 77 82
AO Mean Pressure 104 89 110
LV pressure and LVEDP was: 2/13/2023
LV Systolic Pressure 100
LV Diastolic Pressure 14
LV End Diastolic Pressure 16
Some recent data might be hidden
There was no gradient between the left ventricle and aorta. Fluoroscopy shows below my minimal calcification was noted descending aorta severely calcified. Ascending and also shows
Angiographic Data:
Right coronary artery arises from the right sinus of Valsalva it is a dominant vessel and some by bifurcating into posterior descending artery posterolateral ventricular branch no obstructive disease was noted and its course or its branches
Left main artery arises from the left sinus of Valsalva medium-size vessel with no obstructive disease
Left anterior descending artery arises from the left main artery runs in the interventricular groove some plaque irregularities noted numerous small it is size diagonal branches and numerous septal branches were noted mid to distal segment has got tubular 20-30% lesion but no significant obstructive disease was seen.
Left circumflex artery arises from the left main artery runs in the interventricular groove gives rise to large-sized 1st obtuse marginal branch then continues in AV groove branch some plaque irregularities noted throughout its course but no significant obstructive disease was noted
Left ventriculogram performed in 30 degree RAO projection LVEDP 16 mm of mercury with no regional wall motion abnormality normal function ejection fraction is 65-70%
Descending aortography was performed in AP projection. There is a calcification and the mid segment of the descending aorta infrarenal shows some constriction but no significant obstructive disease was noted there was no aneurysm noted. Celiac trunk was seen with hepatic and splenic vessels were noted with no stenosis. Bilateral renal artery were noted some calcification no significant stenosis is noted superior mesenteric artery does not show any stenosis arises posteriorly from the aorta and bilateral common iliac artery shows some ectatic segments and some dilatation specially of the left common iliac artery with no stenosis
Final Diagnosis:
1. Atherosclerotic heart disease luminal irregularity of the coronary artery but no obstructive disease.
2. Normal left ventricular systolic function
3. Calcified descending aorta with no infrarenal abdominal aortic aneurysm. Celiac trunk asymmetric bilateral renal artery does show any stenosis bilateral common iliac artery does show any stenosis