bhargavi
Guru
After obtaining informed consent, the patient was prepped and draped in sterile fashion. A 6 French glide sheath/sheath was inserted in the right radial artery. Radial cocktail consisting of 5 mg of verapamil and 200 mg of nitroglycerin was administered via right radial artery sheath to prevent radial artery spasm. Attempted delivering the catheter and wire through the right subclavian but due to presence of bovine arch, diagnostic catheter and wire manipulation was difficult. Therefore, 6 French right common femoral artery access was obtained. A 6 French Judkins left and right coronary catheters was used for left and right coronary angiography. Iliofemoral angiography revealed presence of sheath in the common femoral artery. A mynx closure device was used to close the right common femoral artery access site. 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 11:48 AM and end time was 12:06 PM. There were no complications. See nurse's sedation sheet, for complete pre-and post service details.
Hemodynamics:
The left ventricular end diastolic pressure was 35 mmHg. The aortic pressure was 183/92 mmHg.
Coronary Angiography:
Right coronary artery is a large-caliber co-dominant vessel with mild proximal disease, patent mid segment and patent distal vessel. RPDA is a medium to large caliber vessel luminal irregularities.
Left Main coronary artery is of large caliber and appears to be patent.
Left anterior descending is a large caliber vessel with patent proximal segment, mid 30 to 40% stenosis, patent distal segment. There are 3 small diagonal branches with luminal irregularities.
Left circumflex is a large-caliber codominant vessel with patent proximal, mid, and distal segment. Obtuse marginal 1 is a large caliber vessel with luminal irregularities. Obtuse marginal 2 is a medium to large caliber vessel luminal irregularities. Obtuse marginal 3 is a large caliber vessel with patent proximal segment, mild mid vessel disease, patent distal segment. LPL is a medium caliber vessel luminal irregularities.
Left ventriculogram: Left ventricular cavity was entered using 6 French Tiger catheter and LVEDP was measured at 35 mmHg.
Right subclavian angiography revealed patent subclavian artery without evidence of aneurysm or stenosis.
The patient was then transferred to the recovery area in stable condition:
thanks in advance
should I do 93458, 36216 or 93459? since rt subclavian angio done*
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 11:48 AM and end time was 12:06 PM. There were no complications. See nurse's sedation sheet, for complete pre-and post service details.
Hemodynamics:
The left ventricular end diastolic pressure was 35 mmHg. The aortic pressure was 183/92 mmHg.
Coronary Angiography:
Right coronary artery is a large-caliber co-dominant vessel with mild proximal disease, patent mid segment and patent distal vessel. RPDA is a medium to large caliber vessel luminal irregularities.
Left Main coronary artery is of large caliber and appears to be patent.
Left anterior descending is a large caliber vessel with patent proximal segment, mid 30 to 40% stenosis, patent distal segment. There are 3 small diagonal branches with luminal irregularities.
Left circumflex is a large-caliber codominant vessel with patent proximal, mid, and distal segment. Obtuse marginal 1 is a large caliber vessel with luminal irregularities. Obtuse marginal 2 is a medium to large caliber vessel luminal irregularities. Obtuse marginal 3 is a large caliber vessel with patent proximal segment, mild mid vessel disease, patent distal segment. LPL is a medium caliber vessel luminal irregularities.
Left ventriculogram: Left ventricular cavity was entered using 6 French Tiger catheter and LVEDP was measured at 35 mmHg.
Right subclavian angiography revealed patent subclavian artery without evidence of aneurysm or stenosis.
The patient was then transferred to the recovery area in stable condition:
thanks in advance
should I do 93458, 36216 or 93459? since rt subclavian angio done*