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need help with angio?

bhargavi

Networker
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Conclusion

PROCEDURES
1. Ascending aortogram.
2. Left subclavian angiography
3. Attempted percutaneous intervention of left subclavian.
4. 6 French Mynx vascular closure for left femoral artery access

PROCEDURE NOTE
Informed consent was obtained after explaining risks and benefits to the patient. Right groin was draped and prepped in the sterile fashion. Patient was premedicated with 50 mg of p.o. Benadryl, 1 mg of Versed, and 50 mcg of fentanyl. After injecting 2% lidocaine in the right groin, right common femoral artery was accessed using micropuncture needle and a 5 French sheath was inserted without any difficulty. 6 French pigtail catheter was advanced and ascending aortogram was performed. Pigtail catheter was removed and 6 cm x 90 cm destination catheter was advanced into the thoracic aorta. Patient was proceeded with intervention of the left subclavian. Patient remained hemodynamically stable and tolerated procedure well. Patient was stable without any discomfort at the procedure.

ABDOMINAL AORTOGRAM
Ascending aorta was patent with mild dilatation and patent right subclavian, right common carotid, left common carotid arteries.
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LEFT SUBCLAVIAN ANGIOGRAM
Left subclavian artery was 100% occluded in its proximal portion.

PERCUTANEOUS INTERVENTION OF
6 French 90 cm destination sheath was advanced over a Magic torque wire and the proximal end of the sheath was placed in the thoracic aorta. 70 units/kg heparin was used for anticoagulation. IMA catheter was used to engage the left subclavian artery. Attempted crossing the lesion with V 18 wire, then Magic torque wire, and then victory wire. We were able to cross the lesion using the victory wire but we were unable to advance to a crossing catheter through the lesion. At this point procedure was aborted and destination sheath was removed. Right common femoral artery access was closed using mynx closure device

IMPRESSION
1. Left subclavian stenosis.
2. PAD
3. HTN

RECOMMENDATIONS
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We will continue with medical management for now. Patient will be brought back for repeat intervention of left subclavian via left brachial access. We will schedule this in the upcoming 1-2 weeks.
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I am thinking 36221? the physician also want to bill for attempted intervention also . I code for hospital
thank you in advance
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