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The patient is a 68-year-old who presented with stuttering symptoms of shortness of breath and diaphoreses that is disproportionate to his baseline. He experienced profound symptoms after walking up a hill as well as while golfing. He underwent an exercise treadmill test where he had an adequate exercise performance and was similar to his baseline. However, with increased concerning symptoms, he elected to proceed with angiography.
Of note, the patient did have an echo that demonstrated a moderate sever eccentric aortic insufficiency although normal chamber dimensions, difficult to assess by echo due to the eccentricity of the AI and therefore, it was determined that due to this concern of aortic insufficiency that he will have an aortogram as well.
Procedure: Informed consent was obtained, the patient understood the risks, benefits and alternatives procedure and agreed to proceed with the procedure. The right wrist was prepped in the usual sterile fashion and 2% lidocaine infused subcutaneously until adequate anesthesia was obtained. Right radial artery was accessed using modified Seldinger technique of which a 6 French 250 mm Glidesheath was placed without complication. Diagnostic Jacky catheter was used to perform selective coronary angiography and a pigtail catheter for aortography. Left heart catherization was also performed with the Jacky catheter. At the conclusion of the procedure, a TR band was used for homeostasis.
Hemodynamics: Left ventricular end-diastolic pressure measured 10 mmHg. No transaortic gradient on pullback.
Left Ventriculography: Demonstrated preserved left ventricular function, ejection fraction of 55%. Aortography demonstrated 4+ severe aortic insufficiency fully opacifying the left ventricle in a single beat.
Coronary Angiography:
Left Main: No significant disease.
LAD: Eccentric lesion seen in the midvessel segment. This was eccentric and potentially a bend of 50-70% and otherwise was an intermediate. The first and second diagonal had mild disease.
Circumflex: Gave off two prominent marginals with mild disease and no significant obstruction.
RCA: Dominant vessel fiving off PDA branch that had mild nonobstructive disease.
Summary: Intermediate lesion seen in the mid LAD as well as severe 4+ aortic insufficiency.
Intervention: In light of the intermediate lesion, FFR was employed to better qualify the significance of the lesion. Heparin was used for effective anticoagulation. An EBU 3.75 guide catheter was used to intubate the left main coronary artery. A RADI wire was placed to the distal vessel and maximal hyperemia was achieved
Now I am billing
93458-26 LHC
93571-LD-26 FFR
93567-59 Aortogram?
Am I correct on the Aortogram, that's where I am confused or do I use 75625
Thanks Nancy
Of note, the patient did have an echo that demonstrated a moderate sever eccentric aortic insufficiency although normal chamber dimensions, difficult to assess by echo due to the eccentricity of the AI and therefore, it was determined that due to this concern of aortic insufficiency that he will have an aortogram as well.
Procedure: Informed consent was obtained, the patient understood the risks, benefits and alternatives procedure and agreed to proceed with the procedure. The right wrist was prepped in the usual sterile fashion and 2% lidocaine infused subcutaneously until adequate anesthesia was obtained. Right radial artery was accessed using modified Seldinger technique of which a 6 French 250 mm Glidesheath was placed without complication. Diagnostic Jacky catheter was used to perform selective coronary angiography and a pigtail catheter for aortography. Left heart catherization was also performed with the Jacky catheter. At the conclusion of the procedure, a TR band was used for homeostasis.
Hemodynamics: Left ventricular end-diastolic pressure measured 10 mmHg. No transaortic gradient on pullback.
Left Ventriculography: Demonstrated preserved left ventricular function, ejection fraction of 55%. Aortography demonstrated 4+ severe aortic insufficiency fully opacifying the left ventricle in a single beat.
Coronary Angiography:
Left Main: No significant disease.
LAD: Eccentric lesion seen in the midvessel segment. This was eccentric and potentially a bend of 50-70% and otherwise was an intermediate. The first and second diagonal had mild disease.
Circumflex: Gave off two prominent marginals with mild disease and no significant obstruction.
RCA: Dominant vessel fiving off PDA branch that had mild nonobstructive disease.
Summary: Intermediate lesion seen in the mid LAD as well as severe 4+ aortic insufficiency.
Intervention: In light of the intermediate lesion, FFR was employed to better qualify the significance of the lesion. Heparin was used for effective anticoagulation. An EBU 3.75 guide catheter was used to intubate the left main coronary artery. A RADI wire was placed to the distal vessel and maximal hyperemia was achieved
Now I am billing
93458-26 LHC
93571-LD-26 FFR
93567-59 Aortogram?
Am I correct on the Aortogram, that's where I am confused or do I use 75625
Thanks Nancy