bhargavi
Guru
Left heart cath
Percutaneous coronary intervention
Procedure Log
Conclusion
XT 4-year-old male with history of coronary artery disease status post coronary artery bypass graft surgery and multiple interventions presenting with recurrence of severe chest discomfort and elevated troponin with non-ST elevation myocardial infarction was brought in for coronary angiogram. Procedure, risks, benefits, alternative options were explained. Risks including bleeding, infection, cerebrovascular accident, myocardial infarction, death, and arrhythmia were all explained patient was agreeable. He was brought into the cardiac cath lab where conscious sedation (moderate sedation) was performed by myself using Versed and fentanyl. Conscious sedation was started 10:40 AM and monitoring period Ended 11:38 AM. I was present throughout this whole entire period With the patient. Both groins were prepped and draped in the usual fashion. 2% lidocaine was used to anesthesize the skin. Using modified Seldinger technique, a 6 French sheath was inserted in the right femoral artery. Cardiac catheterization was performed using the usual catheters.
Finding:
1: Vein graft to the right coronary artery has a mid area of 50% in-stent restenosis that appears to be unchanged from recent angiogram
2: Vein graft to the left circumflex artery has an ostial haziness with 90% stenosis. The area of recent angioplasty appears to be widely patent in the middle of the vessel.
3: I did not inject the native coronaries as the patient had recent angiogram.
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Impression: There is stenosis in the origin of the vein graft to the left circumflex artery.
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Plan: Balloon angioplasty to the ostium of the vein graft to the left circumflex artery.
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Intervention:
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Using a L CB guiding catheter and a ATW marker wire I was able to cross to severe stenosis in the ostium of the vein graft to the left circumflex artery. The area was predilated with a 3.0 x 15 followed by 3.5 x 12 mm balloon. I also did balloon angioplasty in the mid vein graft at the area of recent angioplasty where there appears to be residual 30% stenosis. This responded very well with no residual stenosis. Repeat angiogram showed excellent result and no residual stenosis.
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Final impression:
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Severe stenosis in the origin of the vein graft to the left circumflex artery successfully treated with insertion of 3.5 mm balloon.
*
thank you in advance
should I code 92920 or 92937-lc- since its graft ptca?
*
Percutaneous coronary intervention
Procedure Log
Conclusion
XT 4-year-old male with history of coronary artery disease status post coronary artery bypass graft surgery and multiple interventions presenting with recurrence of severe chest discomfort and elevated troponin with non-ST elevation myocardial infarction was brought in for coronary angiogram. Procedure, risks, benefits, alternative options were explained. Risks including bleeding, infection, cerebrovascular accident, myocardial infarction, death, and arrhythmia were all explained patient was agreeable. He was brought into the cardiac cath lab where conscious sedation (moderate sedation) was performed by myself using Versed and fentanyl. Conscious sedation was started 10:40 AM and monitoring period Ended 11:38 AM. I was present throughout this whole entire period With the patient. Both groins were prepped and draped in the usual fashion. 2% lidocaine was used to anesthesize the skin. Using modified Seldinger technique, a 6 French sheath was inserted in the right femoral artery. Cardiac catheterization was performed using the usual catheters.
Finding:
1: Vein graft to the right coronary artery has a mid area of 50% in-stent restenosis that appears to be unchanged from recent angiogram
2: Vein graft to the left circumflex artery has an ostial haziness with 90% stenosis. The area of recent angioplasty appears to be widely patent in the middle of the vessel.
3: I did not inject the native coronaries as the patient had recent angiogram.
*
Impression: There is stenosis in the origin of the vein graft to the left circumflex artery.
*
Plan: Balloon angioplasty to the ostium of the vein graft to the left circumflex artery.
*
Intervention:
*
Using a L CB guiding catheter and a ATW marker wire I was able to cross to severe stenosis in the ostium of the vein graft to the left circumflex artery. The area was predilated with a 3.0 x 15 followed by 3.5 x 12 mm balloon. I also did balloon angioplasty in the mid vein graft at the area of recent angioplasty where there appears to be residual 30% stenosis. This responded very well with no residual stenosis. Repeat angiogram showed excellent result and no residual stenosis.
*
Final impression:
*
Severe stenosis in the origin of the vein graft to the left circumflex artery successfully treated with insertion of 3.5 mm balloon.
*
thank you in advance
should I code 92920 or 92937-lc- since its graft ptca?
*