Wiki need help coding cath

bhargavi

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Coronary artery disease, angina presence unspecified, unspecified vessel or lesion type, unspecified whether native or transplanted heart [I25.10 (ICD-10-CM)]​

Conclusion




This patient with prior treatment for cocaine abuse, tobacco abuse, hypertension, morbid obesity, prior abnormal stress test presented to Sussex campus after a out-of-hospital cardiac arrest. Patient was noted to be unresponsive at home and wife started CPR. 911 was called and upon EMS arrival patient was in PEA arrest. After receiving 1 dose of epinephrine and CPR, ROSC was obtained. He was intubated in the field for airway protection. Patient was found to have troponin elevation of 110 over the weekend.   Patient had a left heart catheterization which revealed severe multivessel coronary disease.  Viability study was inconclusive.  Decision was made to attempt percutaneous coronary intervention of LAD and possibly bare-metal stent implantation.

After obtaining informed consent, the patient was prepped and draped in sterile fashion. A 6 French glide sheath was inserted in the right radial artery. Radial cocktail consisting of 2.5 mg of verapamil and 200 mg of nitroglycerin was administered via right radial artery sheath prevent radial artery spasm. A 6 French EBU 3.5 guide was used for left coronary angiography. TR band was placed on right radial artery access site for patent hemostasis.

I attest that moderate conscious sedation was provided under my direct supervision with the sedation trained nurse using 1 mg of intravenous Versed and 50 mcg of fentanyl to sedate the patient. Start time 10:19 AM and end time was 11:31 AM. There were no complications. See nurse's sedation sheet, for complete pre-and post service details.

Hemodynamics:

The aortic pressure was 140/77 mmHg.

Coronary Angiography:

Left Main coronary artery is patent.

Left anterior descending is a large caliber vessel with 100% mid occlusion at diagonal 1 bifurcation. Distal LAD is filling via left to left collaterals. There is a medium to large caliber diagonal 1 branch with luminal irregularities.

Left circumflex is a small caliber nondominant vessel with proximal 40 to 50% stenosis, patent mid to distal segment. Obtuse marginal 1 is a medium caliber vessel with mid 100% occlusion and distal vessel filled via left to left collaterals. Obtuse marginal 2 is a small to medium caliber vessel with severe ostial disease, proximal subtotal occlusion with distal TIMI I to TIMI II flow. Obtuse marginal 3 is a small to medium caliber vessel with mild diffuse disease.

Ramus intermedius is a large caliber vessel with luminal irregularities.

The patient was then transferred to the recovery area in stable condition:

Summary conclusion:

1. Multivessel coronary disease.
2. Large non-ST segment elevation myocardial infarction.
3. Ischemic dilated cardiomyopathy with most recent ejection fraction of 20 to 25%
4. Hypertension
5. Dyslipidemia
6. Nonsustained ventricular tachycardia
7. Aspiration pneumonia
8. Status post ventilator dependent respiratory failure.

Recommendation:

Attempt PCI of chronic total occlusion of mid LAD.  Next

6 French EBU 3.5 guide was used to engage left coronary system.  Patient was anticoagulated using 90 units/kg heparin.  Run-through wire was advanced into mid LAD.  Docking wire was used to extend the length of run-through wire.  An over-the-wire 1.5 x 8 mm balloon was advanced into mid LAD.  Run-through wire was removed.  Fielder XT 300 cm wire was used to explore the micro channel which was unsuccessful.  Using wire escalation technique pilot 200 300 cm wire was finally advanced into distal LAD through the mid chronic total occlusion.  Attempted to advance to 1.5 x 8 mm balloon through the lesion which was unsuccessful.  Balloon angioplasty was performed in the mid LAD at diagonal 2 bifurcation.  At this point procedure was aborted due to prolonged radiation exposure and IV contrast dye exposure.  After wire removal angiography was performed which revealed micro channel feeding the distal LAD.  Patient is scheduled to undergo three-vessel coronary artery bypass grafting with CT surgery tomorrow.​


thanks in advance
should I do CTO-92943- LD? or 92920-ld? for this patient diagnostic cath was done week prior . and he is inpatient.


















 
























 
Based on what I am reading they were trying to treat the mid LAD which is not where the CTO is. If that is correct use 92920
 
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