LHC with SVG additional arterial acess with PCI

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Need a little help with this. Unsure of the correct codes to use during the catherization. Can I also code 36140 for additional arterial access in the femoral artery with 93459-26-59 & 92937 ?

Procedure:
1. Right radial access
2. Right femoral artery access
3. LHC
4. Left ventriculogram
5. Aortogram to assess the patency of grafts
6. Saphenous vein graft angiography
7. PCI of SVG to OM with placement of drug eluting stents

Procedure Details:

The risks, benefits, complications, treatment options. and expected outcomes were discussed with patient. The patients and/or family concurred with the proposed plan, giving informed consent. Patient was brought to the cath lab after IV hydration was begun and oral premeditation was given. Patient was further sedated with fentanyl and versed. Patients was prepped and draped in the usual manner. Using the modified seldinger access technique, a 6 french sheath was placed in the Rt Radial artery. A left heart catherization was done. Right and left coronary angiograms were done. The patient experienced significant spasm in the brachial artery. Decision was made to proceed with the right groin access. A 6 french sheath was applied without any immediate problem and then diagnostic intervention was performed. Then an LCB guiding catheter was used to engage with the vein graft to the OM2 & prowater wire was advanced across the lesion and then direct stenting with a 2.5 x 12 Promus Premier stent that was deployed as 12 atmospheres, abolishing an 80% lesion down to 0, obtaining TIMI 3 flow pre and post with 0 residue.

Pigtail catheter used to do a selective aortogram in LAO view to assess the patency of the vein graft to the LAD, which appears to be occluded graft to the RCA & OM was visualized, bu no other grafts noted.

After the procedure was completed, sedation was stopped and the sheaths and catheters were all removed. Hemostasis was achieved with manual pressure.

Findings:

Hemodyamics LVEDP 8MMHG, No LV-Ao gradient
Left Main Normal Mild disease
LAD mid 100%
RCA Ostial 100%
Circ Patent stents, OM2 100%
SVG to Distal RCA Patent & OM2 89% at distal anastomosis,
Aortogram Normal Size No Dissection, Moderate atherosclerosis,
Patent 2 grafts. Origin of great vessels patent.
LV LV angiogram was done and revealed normal wall motion and normal contractility. Ejection fraction is 45%
ACC Type B1
Vessel Dominance RCA
Interventions YES SVG to OM2
Anticoagulants ASA/PLAVIX
Catheter used LCB Guide
Closure Device Angioseal

Thank you!
 
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