willnat2
Networker
I could really use some help with this. We have a new physician and he is doing Carotid Angiograms.
Cath Procedure
Pre-procedure diagnosis:
Resuscitated cardiac arrest.
Non ST-elevation Myocardial infarction.
Post-Procedure diagnosis:
Severe coronary artery disease with 80% left main stenosis, 90% LAD stenosis.
Preserved LV systolic function, EF65%.
Severe right carotid artery stenosis, normal left carotid artery.
Good size LIMA.
Resucitated cardiac arrest, with unknown extent of brain injury.
Procedure performed: diag coronary angiography, left heart cath, left ventrculogram, Bilateral selective carotid angiogram. LIMA angiogram. Placement of intra-aortic balloon pump.
Procedure details:
Vascular access obtained via right femoral artery with micropuncture technique 6 French sheath placed.
Six French pigtail, JR and JL catheters used for left heart catheterization in diagnostic angiogram.
JR4 6 French catheter used for selective carotid angiogram and LIMA angiogram.
Six French sheath exchanged for the 7 French balloon pump sheath.
Balloon pump 50 cc advanced on the floor control to the descending aorta with the tip at the left main bronchus and counterpulsation with one-to-one effectively.
Findings:
Hemodynamics:
Opening the arterial pressure 150/80 mm HG.
Left ventricular pressure 150/5/20 mm Hg with LVEDP of 20 mm Hg.
There was no LV to aorta gradient.
With counterpulsation with intra-aortic balloon pump at one-tone the mean arterial pressure 90 mm Hg.
Left Ventriculogram:
Left ventricle appears of normal size with overall preserved LV ejection fraction of 60-65%.
Angiogram was obtained with the pigtail catheter positioned to the mid LV in RAO projection and manual injection of 10 cc of contrast.
Selective Coronary Angiogram:
Right dominant circulation.
Left main is large vessel which has long ostial proximal 80% stenosis.
LAD is a medium-sized vessel, proximal LAD has luminal irregularities but no significant stenosis: it gives large branching 1st diagonal branch which has proximal 70% stenosis, beyond the bifurcation with the diagonal the mid LAD has long 90% stenosis.
Circumflex is relatively small nondominant vessel OM 1 has 80% stenosis of M@ free of significant disease.
Large dominant right coronary artery has moderate luminal irregularity but no significant stenosis.
Selective Carotid Angiogram:
In expectation of urgent/emergent bypass surgery carotid angiogram was obtained.
Both: Right and then left common carotid artery were cannulated with 6 French JR4 catheter.
Right common carotid artery is large vessel without any significant stenosis the right external carotid arteries patent, the right internal carotid artery has severe 90% proximal stenosis.
Left common carotid artery is a large vessel without any significant stenosis, left internal carotid artery is a large vessel without evidence of stenosis, left external carotid artery is patent.
LIMA is a medium-sized vessel suitable for bypass.
I am not sure what to code for this:
93459
33967
36223-50 or 36222-50
Any help would be greatly appreciated.
Thank you
Cath Procedure
Pre-procedure diagnosis:
Resuscitated cardiac arrest.
Non ST-elevation Myocardial infarction.
Post-Procedure diagnosis:
Severe coronary artery disease with 80% left main stenosis, 90% LAD stenosis.
Preserved LV systolic function, EF65%.
Severe right carotid artery stenosis, normal left carotid artery.
Good size LIMA.
Resucitated cardiac arrest, with unknown extent of brain injury.
Procedure performed: diag coronary angiography, left heart cath, left ventrculogram, Bilateral selective carotid angiogram. LIMA angiogram. Placement of intra-aortic balloon pump.
Procedure details:
Vascular access obtained via right femoral artery with micropuncture technique 6 French sheath placed.
Six French pigtail, JR and JL catheters used for left heart catheterization in diagnostic angiogram.
JR4 6 French catheter used for selective carotid angiogram and LIMA angiogram.
Six French sheath exchanged for the 7 French balloon pump sheath.
Balloon pump 50 cc advanced on the floor control to the descending aorta with the tip at the left main bronchus and counterpulsation with one-to-one effectively.
Findings:
Hemodynamics:
Opening the arterial pressure 150/80 mm HG.
Left ventricular pressure 150/5/20 mm Hg with LVEDP of 20 mm Hg.
There was no LV to aorta gradient.
With counterpulsation with intra-aortic balloon pump at one-tone the mean arterial pressure 90 mm Hg.
Left Ventriculogram:
Left ventricle appears of normal size with overall preserved LV ejection fraction of 60-65%.
Angiogram was obtained with the pigtail catheter positioned to the mid LV in RAO projection and manual injection of 10 cc of contrast.
Selective Coronary Angiogram:
Right dominant circulation.
Left main is large vessel which has long ostial proximal 80% stenosis.
LAD is a medium-sized vessel, proximal LAD has luminal irregularities but no significant stenosis: it gives large branching 1st diagonal branch which has proximal 70% stenosis, beyond the bifurcation with the diagonal the mid LAD has long 90% stenosis.
Circumflex is relatively small nondominant vessel OM 1 has 80% stenosis of M@ free of significant disease.
Large dominant right coronary artery has moderate luminal irregularity but no significant stenosis.
Selective Carotid Angiogram:
In expectation of urgent/emergent bypass surgery carotid angiogram was obtained.
Both: Right and then left common carotid artery were cannulated with 6 French JR4 catheter.
Right common carotid artery is large vessel without any significant stenosis the right external carotid arteries patent, the right internal carotid artery has severe 90% proximal stenosis.
Left common carotid artery is a large vessel without any significant stenosis, left internal carotid artery is a large vessel without evidence of stenosis, left external carotid artery is patent.
LIMA is a medium-sized vessel suitable for bypass.
I am not sure what to code for this:
93459
33967
36223-50 or 36222-50
Any help would be greatly appreciated.
Thank you