spielmar
New
Hello,
PLEASE HELP!!! New to vascular coding! I thought I had this figured out, but it seems I don't know what I'm doing. I cannot figure out how to code these. I don't understand how I'm told to code the 75710 as well, when CCI edits state that it's included with both the 37236 and the 36215.
I have it coded as
37236 for the PTA
36215 for the cath placement
93455 for the heart cath
99152 for the sedation
Pre Procedure Indication / Diagnosis:
1. Non Q MI
2. Left arm pain (Known stent in left subclavian? Stenosis) - R/O Steal syndrome
3. Known CAD / CABG 2011
Post procedure Diagnosis:
1. Same
2. Severe stenosis in left subclavian stent
3. Successful PTA of the left subclavia
4. Patent LIMA -LAD, SVG -D and SVG-OM2
5. Moderate to severe disease in small RCA
Pre Procedure Conscious Evaluation:
ASA Class: I II III IV
Mallampati Class: I II III IV
Procedure Performed:
Access: Femoral Radial artery
Right Left
Ultrasound use for guidance: Yes No
Conscious sedation: Yes No
Left Heart Cath LIMA-Grafts LV Gram post AV crossing
Left subclavian angio-selective Abdominal Aorta Run Off
PTCA-DES PTA of Left subclavian IVUS FFR/IFR
Intravascular Infusion (NTG, thrombolytic, Verapamil..) No
Procedure Details: After informed consent was obtained with explanation of the risks and benefits, patient was brought to the cath lab. The access area was prepped and draped in sterile fashion. 1% lidocaine was used for local block. The artery was cannulated with 6 Fr sheath with brisk arterial blood return. The side port was frequently flushed and aspirated with normal saline. The catheter crossed the aortic valve, hemodynamic measurement was documented as below, and LV gram was done or not as indicated below based on patient stability, renal function and .The right coronary artery was engaged and contrast injected with no complication, and findings as below. Then the laft main was engaged to visualize the Lad and LCX arteries as described below.
Aortic pressure: 124/42 mm Hg
LV pressure: 145/-5 mm Hg
Aortic valve gradient: minimal mm Hg
Left subclavian: 57/52 with gradient about 70 mm Hg before treatment with PTA
Coronary Findings:
Dominance: Right Left
Left main: good size. Distal 40-50% stenosis
Left anterior descending artery: 100% proximal area
LIMA -LAD: Patent with steal syndrome due to left subclavian stenosis (90% with gradient 70-80 mm Hg in the ostial area in stent stenosis)
Diagonal 1: Diffuse disease
SVG - D1: patent with no disease
LCX: 100%
SVG-OM: Patent with small OM, diffuse disease not amendable for stent
RCA: Appears to be non dominant, small, with mid area 60-70% stenosis.
The LV gram was performed in the RAO 30 position. Cath
LVEF: 45%. LV Wall Motion: global hypokinesia
Left Subclavuian Angiogram / Intervention:
Using multipurpose ccatheter left ostial subclavian stent idintified occluded with mean gradient about 80 mm Hg before and after we crossed the lesion with glide wire successfully, causing steal syndrom to a large LIMA-LAD.
A Glide wire was used then a 10/40 balloon was advanced in ostial subclavian, inflated to 14 multiple time
Final gradient was < 10 mm Hg, and the area was patent improving flow into the LIMA
Conclusions:
1. Multivessel CAD
2. Mild LV dysfunction
3. Patent LIMA -LAD, SVG -D
4. Patent SVG -OM with small target vessel with 70% stenosis (not amendable for stent)
5. Moderate to severe disease in small RCA
6. Successful PTA of the left subclavian ostial stent to treat the steal syndrom for the LIMA
Recommendation:
1. Post PTCA -stent protocol
Estimated Blood Loss: <10 10-25 25-50 50-100 >100
CONTRAST VOLUME: 85
FLUORO TIME: 20 minutes;
FLUORO DOSE: 301 mGy/cm2
Time of sedation: 45 min
Sedation: Minimal Moderate Deep
Medications Used: Versed & Fentanyl Propofol Morphine Sulfate Valium
Orders given by cardiologist.
I supervised and/or directed an independent trained observer who assisted in monitoring the patient's level of consciousness and physiological status throughout the procedure
PLEASE HELP!!! New to vascular coding! I thought I had this figured out, but it seems I don't know what I'm doing. I cannot figure out how to code these. I don't understand how I'm told to code the 75710 as well, when CCI edits state that it's included with both the 37236 and the 36215.
I have it coded as
37236 for the PTA
36215 for the cath placement
93455 for the heart cath
99152 for the sedation
Pre Procedure Indication / Diagnosis:
1. Non Q MI
2. Left arm pain (Known stent in left subclavian? Stenosis) - R/O Steal syndrome
3. Known CAD / CABG 2011
Post procedure Diagnosis:
1. Same
2. Severe stenosis in left subclavian stent
3. Successful PTA of the left subclavia
4. Patent LIMA -LAD, SVG -D and SVG-OM2
5. Moderate to severe disease in small RCA
Pre Procedure Conscious Evaluation:
ASA Class: I II III IV
Mallampati Class: I II III IV
Procedure Performed:
Access: Femoral Radial artery
Right Left
Ultrasound use for guidance: Yes No
Conscious sedation: Yes No
Left Heart Cath LIMA-Grafts LV Gram post AV crossing
Left subclavian angio-selective Abdominal Aorta Run Off
PTCA-DES PTA of Left subclavian IVUS FFR/IFR
Intravascular Infusion (NTG, thrombolytic, Verapamil..) No
Procedure Details: After informed consent was obtained with explanation of the risks and benefits, patient was brought to the cath lab. The access area was prepped and draped in sterile fashion. 1% lidocaine was used for local block. The artery was cannulated with 6 Fr sheath with brisk arterial blood return. The side port was frequently flushed and aspirated with normal saline. The catheter crossed the aortic valve, hemodynamic measurement was documented as below, and LV gram was done or not as indicated below based on patient stability, renal function and .The right coronary artery was engaged and contrast injected with no complication, and findings as below. Then the laft main was engaged to visualize the Lad and LCX arteries as described below.
Aortic pressure: 124/42 mm Hg
LV pressure: 145/-5 mm Hg
Aortic valve gradient: minimal mm Hg
Left subclavian: 57/52 with gradient about 70 mm Hg before treatment with PTA
Coronary Findings:
Dominance: Right Left
Left main: good size. Distal 40-50% stenosis
Left anterior descending artery: 100% proximal area
LIMA -LAD: Patent with steal syndrome due to left subclavian stenosis (90% with gradient 70-80 mm Hg in the ostial area in stent stenosis)
Diagonal 1: Diffuse disease
SVG - D1: patent with no disease
LCX: 100%
SVG-OM: Patent with small OM, diffuse disease not amendable for stent
RCA: Appears to be non dominant, small, with mid area 60-70% stenosis.
The LV gram was performed in the RAO 30 position. Cath
LVEF: 45%. LV Wall Motion: global hypokinesia
Left Subclavuian Angiogram / Intervention:
Using multipurpose ccatheter left ostial subclavian stent idintified occluded with mean gradient about 80 mm Hg before and after we crossed the lesion with glide wire successfully, causing steal syndrom to a large LIMA-LAD.
A Glide wire was used then a 10/40 balloon was advanced in ostial subclavian, inflated to 14 multiple time
Final gradient was < 10 mm Hg, and the area was patent improving flow into the LIMA
Conclusions:
1. Multivessel CAD
2. Mild LV dysfunction
3. Patent LIMA -LAD, SVG -D
4. Patent SVG -OM with small target vessel with 70% stenosis (not amendable for stent)
5. Moderate to severe disease in small RCA
6. Successful PTA of the left subclavian ostial stent to treat the steal syndrom for the LIMA
Recommendation:
1. Post PTCA -stent protocol
Estimated Blood Loss: <10 10-25 25-50 50-100 >100
CONTRAST VOLUME: 85
FLUORO TIME: 20 minutes;
FLUORO DOSE: 301 mGy/cm2
Time of sedation: 45 min
Sedation: Minimal Moderate Deep
Medications Used: Versed & Fentanyl Propofol Morphine Sulfate Valium
Orders given by cardiologist.
I supervised and/or directed an independent trained observer who assisted in monitoring the patient's level of consciousness and physiological status throughout the procedure