Alfaro33
Networker
MD coded 93458. I was thinking of just coding the Femoral Angio and/or the LHC with a discontinued procedure modifier?
indication:
1. 68-year-old gentleman with elevated troponin level and hypertension
2. Recent nuclear stress test and echocardiogram within normal limits
3. Ongoing abdominal and epigastric discomfort and pain and anemia
4. I reviewed the procedure of cardiac catheterization with the patient with all the potential complications, and the patient consented to proceed.
CATHETERIZATION TECHNIQUE: After the usual preparation and premedication, the patient was brought to the cardiac catheterization laboratory. Under sterile conditions,
the right groin was prepped and 2% Xylocaine was used to infiltrate the skin. The right femoral artery was easily cannulated and a 6-French sheath was left in place. After this,
using a type 4,A2,6 French multipurpose catheter over an appropriate guidewire was passed retrograde but at the level of the eye aortic bifurcation the J-wire stopped and therefore
the J-wire was removed and angiogram using 10 cc of contrast agent showed the possibility of distal abdominal aortic dissection and therefore no further attempt with any catheter
or wire was done and I explained this to the patient and removed all the catheters.
The existing right groin sheath was removed and was replaced by a 6 French Angio-Seal closure device with excellent hemostasis accomplished at the right femoral arterial puncture site.
The patient tolerated the entire procedure very well and had no complication during or after the procedure.
I recommended that the patient should undergo appropriate testing including abdominal angiogram to exclude the possibility of prior abdominal aortic dissection especially of the descending
aorta which may be causing his symptom of epigastric discomfort and the endoscopic procedures in the past were normal.
Findings:
Right femoral angiogram revealing the possibility of distal abdominal I aortic dissection, which needs clarification by abdominal aortic angiography
Diagnosis:
Recommendations:
1. I reviewed the findings of the right femoral angiogram with the patient the entire medical team and this patient will most likely consider undergoing abdominal aortic angiogram to exclude
the possibility of abdominal aortic dissection and appropriate management thereafter.
indication:
1. 68-year-old gentleman with elevated troponin level and hypertension
2. Recent nuclear stress test and echocardiogram within normal limits
3. Ongoing abdominal and epigastric discomfort and pain and anemia
4. I reviewed the procedure of cardiac catheterization with the patient with all the potential complications, and the patient consented to proceed.
CATHETERIZATION TECHNIQUE: After the usual preparation and premedication, the patient was brought to the cardiac catheterization laboratory. Under sterile conditions,
the right groin was prepped and 2% Xylocaine was used to infiltrate the skin. The right femoral artery was easily cannulated and a 6-French sheath was left in place. After this,
using a type 4,A2,6 French multipurpose catheter over an appropriate guidewire was passed retrograde but at the level of the eye aortic bifurcation the J-wire stopped and therefore
the J-wire was removed and angiogram using 10 cc of contrast agent showed the possibility of distal abdominal aortic dissection and therefore no further attempt with any catheter
or wire was done and I explained this to the patient and removed all the catheters.
The existing right groin sheath was removed and was replaced by a 6 French Angio-Seal closure device with excellent hemostasis accomplished at the right femoral arterial puncture site.
The patient tolerated the entire procedure very well and had no complication during or after the procedure.
I recommended that the patient should undergo appropriate testing including abdominal angiogram to exclude the possibility of prior abdominal aortic dissection especially of the descending
aorta which may be causing his symptom of epigastric discomfort and the endoscopic procedures in the past were normal.
Findings:
Right femoral angiogram revealing the possibility of distal abdominal I aortic dissection, which needs clarification by abdominal aortic angiography
Diagnosis:
Recommendations:
1. I reviewed the findings of the right femoral angiogram with the patient the entire medical team and this patient will most likely consider undergoing abdominal aortic angiogram to exclude
the possibility of abdominal aortic dissection and appropriate management thereafter.