Need quick help with cath/ptca

Jane5711

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Hi Can anyone help me with coding this?

PROCEDURES PERFORMED:
1. Left heart cardiac catheterization.
2. Selective coronary artery angiography.
3. Left ventriculography.
4. Right heart cardiac catheterization.
5. Selective bilateral renal artery angiography.
6. CSI orbital atherectomy of the mid left anterior descending artery.
7. Angioplasty and stent of the mid left anterior descending artery using a
3.0/18 mm Xience Alpine Everolimus drug-eluting stent, post-dilated with
a 3.25 mm balloon.
8. Percutaneous transluminal coronary angioplasty and stent of the mid left
circumflex artery using a 2.5/15 mm Xience Alpine Everolimus
drug-eluting stent.
9. Percutaneous transluminal coronary angioplasty and stenting of the
ostial proximal portion of the third diagonal branch with a 2.25/12 mm
Xience Alpine Everolimus drug-eluting stent.

INDICATIONS:
1. Multi-vessel coronary artery disease with anterior wall ischemia and
inferior wall ischemia.
2. Symptoms of dyspnea and fatigue.
3. Mitral valve regurgitation.
4. Hypertension, hypertensive heart disease, and renal artery
atherosclerosis.
5. Mitral valve regurgitation with cardiomyopathy and dyspnea and fatigue
symptoms.

DESCRIPTION OF PROCEDURE: After the informed consent was obtained, the
patient was prepped and draped in the usual sterile fashion. Lidocaine 2
percent was used for local anesthesia in the right groin. Vascular access
was obtained in the right femoral artery and right femoral vein. Over a
guidewire, a 7-French angiographic sheath was placed in the right femoral
vein and a 6-French angiographic sheath was placed in the right femoral
artery.

A 6-French TD Swan-Ganz catheter was introduced through the right femoral

vein into the pulmonary artery and right heart cardiac catheterization was
performed in a routine fashion.

A 6-French pigtail catheter was introduced over a guidewire into the left
ventricle. Left ventricular hemodynamics was measured and left
ventriculography in the RAO projection was performed. The pigtail catheter
was removed under hemodynamic monitoring from the left ventricle to the
aorta.

Then, a 6-French JL4 catheter was introduced over a guidewire selectively
engaging the left coronary artery and selective left coronary artery
angiography was performed.

Over a guidewire, a 6-French JL4 catheter was introduced selectively over
the right coronary artery and selective right coronary artery angiography
was performed.

A 6-French JR4 catheter was then used to selectively engage the left renal
artery and selective left renal artery angiography was performed.

A 6-French JR4 catheter was then used to selectively engage the right renal
artery and selective right renal artery angiography was performed.

At the end of the diagnostic cardiac catheterization, the guidewire and
diagnostic catheters were removed. Then, the CSI orbital atherectomy of the
mid LAD was performed, following which, angioplasty and stent of the mid LAD
followed, which angioplasty and stent of the ostial proximal portion of the
diagonal branch and then angioplasty and stent of the mid left circumflex
arteries were performed. At the end of the angioplasty and stent of the
procedure, the guidewire and diagnostic catheters were removed. Arterial
sheath and venous sheaths were sutured in place and the patient was
transferred in a stable condition to the floor for further care with no
complications.

HEMODYNAMIC DATA:
1. Pulmonary capillary wedge pressure, 19/19/11 mm.
2. Pulmonary artery 20/6/12 mm.
3. Right ventricle 22/2/5 mm.
4. Right atrium 3/5/2 mm.
5. Left ventricle 193/2/70 mm.
6. Aorta 172/64/76 mm.
7. Follow oxygen saturation; pulmonary artery 78 percent, aorta 100
percent, and right atrium 78 percent.

VASCULAR RESISTANCE:
1. Pulmonary vascular resistance 11.
2. Total pulmonary vascular resistance 131.
3. Systemic vascular resistance 1047.



CARDIAC OUTPUT:
1. Cardiac output by Fick method, 7.37 liters per minute, cardiac index is
3.76 liters per minute mL/m2.
2. Cardiac output by thermodilution technique 5.57 liters per minute,
cardiac index is 2.86 liters per minute m2.

ANATOMIC DATA:
LEFT VENTRICULOGRAPHY:
1. Anterobasal normal.
2. Anterolateral mild-to-moderate hypokinesis.
3. Anteroapical moderate hypokinesis.
4. Distally inferior apical mid hypokinesis.
5. Posterobasal normal.
6. Mid inferior normal.
7. Left ventricular ejection fraction is approximately 45-50 percent visual
estimate with two plus mitral insufficiency noted and mild gradient
across the aortic valve noted.

CORONARY DATA:
1. Calcification noted fluoroscopically in the proximal and mid left
anterior descending artery, proximal left circumflex artery, and
proximal mid right coronary artery.
2. LEFT MAIN CORONARY ARTERY: The left main coronary artery has no
high-grade focal stenosis. There is mild plaquing in its distal portion;
it bifurcates into left anterior descending artery and left circumflex
arteries.
3. LEFT ANTERIOR DESCENDING ARTERY: The left anterior descending artery has
mild disease in its proximal portion.

There are 3 diagonal branches. The proximal LAD has a smooth 20 percent
narrowing up to the origin of the first diagonal branch.

The first diagonal branch is a small-to-medium caliber vessel with mild
disease.

The second diagonal branch arises close to it with an ostial of 40 percent
stenosis.

The second diagonal branch is also a small-to-medium caliber vessel with
mild disease.

The third diagonal branch is a medium caliber vessel with ostial 60 percent
stenosis.

The mid left anterior descending artery involving the origin of the first to
third diagonal branch and just distal to this has a lesion with up to 80
percent stenosis just distal to the origin of the third diagonal branch and
a 40-50 percent stenosis between the first and third diagonal branches.




Mid LAD beyond this has mild disease. It is transapical. Distal LAD has mild
disease. It is a transapical vessel according to round the apex.

4. LEFT CIRCUMFLEX ARTERY: The left circumflex artery has mild disease in
its proximal portion with calcification and 30 percent stenosis in its
proximal portions. It gives rise to a medium-caliber first obtuse
marginal branch.

Mid left circumflex artery has 30-40 percent stenosis with a hazy stenosis
in the mid portion.

It gives rise to AV circumflex artery beyond the origin of the AV circumflex
artery. The mid circumflex artery has 80 percent hazy stenosis as it
bifurcates into second and third obtuse marginal branches. Both second and
third obtuse marginal branches are small-to-medium caliber vessel with mild
disease.

5. Right coronary artery: The right coronary artery is a dominant vessel.
Mild-to-moderate calcification noted in the proximal to mid right
coronary artery.

There is a 40 percent stenosis of the proximal right coronary artery
followed by another 40 percent stenosis in the midportion of the right
coronary artery and mild ectasia just distal to this.

Mid right coronary artery at the second bend has an eccentric 75 percent
stenosis. Distal to this right coronary artery is a mild diffuse disease. It
is a medium caliber vessel.

Distally it bifurcates into the posterolateral branch, which is a medium
caliber vessel with moderate disease distally and 3 posterolateral branches,
which have mild-to-moderate diffuse disease.

6. LEFT RENAL ARTERY: The left renal artery has mild disease with a 30
percent stenosis in the midportion.

7. RIGHT RENAL ARTERY: The right renal artery has mild disease without any
high-grade focal stenosis.

IMPRESSION:
1. Mild-to-moderate decreased left ventricular systolic function with
mild-to-moderate anterolateral and moderate anteroapical hypokinesis
with LVEF in the range of 45 percent with 2 plus mitral insufficiency.
Mild gradient across the aortic valve with near normal pulmonic arterial
wedge pressure and normal pulmonary arterial pressures.
2. Severe 3-vessel coronary artery disease with calcific 80 percent
stenosis of the mid LAD just beyond the origin of the diagonal branch;
50 percent stenosis of the ostial portion of the third diagonal branch;
80 percent stenosis of mid left circumflex artery just prior to its



bifurcation into the 2 obtuse marginal branches; 75 percent stenosis
with calcification of the mid right coronary artery.
3. Patent renal arteries bilaterally with mild disease.

RECOMMENDATIONS:
1. The patient has anteroapical and inferior wall ischemia, but there was
also significant lesion in the left circumflex artery.
2. Recommend further invasive interventional treatment with atherectomy
followed by angioplasty of the LAD and angioplasty of the diagonal
branch with stenting as needed as well as angioplasty of the mid left
circumflex artery. Consider elective atherectomy and angioplasty of the
right coronary artery in the future as a staged procedure.
3. _____ coronary artery disease.

What I come up with is 92928 LD, 92929, LC AND 36252. I'm just checking to make sure I have all the stents and angioplastys. Any help will do. Thanks
 
Last edited:

merjim_m@yahoo.com

Contributor
Messages
23
Best answers
0
Hi Can anyone help me with coding this?

PROCEDURES PERFORMED:
1. Left heart cardiac catheterization.
2. Selective coronary artery angiography.
3. Left ventriculography.
4. Right heart cardiac catheterization.
5. Selective bilateral renal artery angiography.
6. CSI orbital atherectomy of the mid left anterior descending artery.
7. Angioplasty and stent of the mid left anterior descending artery using a
3.0/18 mm Xience Alpine Everolimus drug-eluting stent, post-dilated with
a 3.25 mm balloon.
8. Percutaneous transluminal coronary angioplasty and stent of the mid left
circumflex artery using a 2.5/15 mm Xience Alpine Everolimus
drug-eluting stent.
9. Percutaneous transluminal coronary angioplasty and stenting of the
ostial proximal portion of the third diagonal branch with a 2.25/12 mm
Xience Alpine Everolimus drug-eluting stent.

INDICATIONS:
1. Multi-vessel coronary artery disease with anterior wall ischemia and
inferior wall ischemia.
2. Symptoms of dyspnea and fatigue.
3. Mitral valve regurgitation.
4. Hypertension, hypertensive heart disease, and renal artery
atherosclerosis.
5. Mitral valve regurgitation with cardiomyopathy and dyspnea and fatigue
symptoms.

DESCRIPTION OF PROCEDURE: After the informed consent was obtained, the
patient was prepped and draped in the usual sterile fashion. Lidocaine 2
percent was used for local anesthesia in the right groin. Vascular access
was obtained in the right femoral artery and right femoral vein. Over a
guidewire, a 7-French angiographic sheath was placed in the right femoral
vein and a 6-French angiographic sheath was placed in the right femoral
artery.

A 6-French TD Swan-Ganz catheter was introduced through the right femoral

vein into the pulmonary artery and right heart cardiac catheterization was
performed in a routine fashion.

A 6-French pigtail catheter was introduced over a guidewire into the left
ventricle. Left ventricular hemodynamics was measured and left
ventriculography in the RAO projection was performed. The pigtail catheter
was removed under hemodynamic monitoring from the left ventricle to the
aorta.

Then, a 6-French JL4 catheter was introduced over a guidewire selectively
engaging the left coronary artery and selective left coronary artery
angiography was performed.

Over a guidewire, a 6-French JL4 catheter was introduced selectively over
the right coronary artery and selective right coronary artery angiography
was performed.

A 6-French JR4 catheter was then used to selectively engage the left renal
artery and selective left renal artery angiography was performed.

A 6-French JR4 catheter was then used to selectively engage the right renal
artery and selective right renal artery angiography was performed.

At the end of the diagnostic cardiac catheterization, the guidewire and
diagnostic catheters were removed. Then, the CSI orbital atherectomy of the
mid LAD was performed, following which, angioplasty and stent of the mid LAD
followed, which angioplasty and stent of the ostial proximal portion of the
diagonal branch and then angioplasty and stent of the mid left circumflex
arteries were performed. At the end of the angioplasty and stent of the
procedure, the guidewire and diagnostic catheters were removed. Arterial
sheath and venous sheaths were sutured in place and the patient was
transferred in a stable condition to the floor for further care with no
complications.

HEMODYNAMIC DATA:
1. Pulmonary capillary wedge pressure, 19/19/11 mm.
2. Pulmonary artery 20/6/12 mm.
3. Right ventricle 22/2/5 mm.
4. Right atrium 3/5/2 mm.
5. Left ventricle 193/2/70 mm.
6. Aorta 172/64/76 mm.
7. Follow oxygen saturation; pulmonary artery 78 percent, aorta 100
percent, and right atrium 78 percent.

VASCULAR RESISTANCE:
1. Pulmonary vascular resistance 11.
2. Total pulmonary vascular resistance 131.
3. Systemic vascular resistance 1047.



CARDIAC OUTPUT:
1. Cardiac output by Fick method, 7.37 liters per minute, cardiac index is
3.76 liters per minute mL/m2.
2. Cardiac output by thermodilution technique 5.57 liters per minute,
cardiac index is 2.86 liters per minute m2.

ANATOMIC DATA:
LEFT VENTRICULOGRAPHY:
1. Anterobasal normal.
2. Anterolateral mild-to-moderate hypokinesis.
3. Anteroapical moderate hypokinesis.
4. Distally inferior apical mid hypokinesis.
5. Posterobasal normal.
6. Mid inferior normal.
7. Left ventricular ejection fraction is approximately 45-50 percent visual
estimate with two plus mitral insufficiency noted and mild gradient
across the aortic valve noted.

CORONARY DATA:
1. Calcification noted fluoroscopically in the proximal and mid left
anterior descending artery, proximal left circumflex artery, and
proximal mid right coronary artery.
2. LEFT MAIN CORONARY ARTERY: The left main coronary artery has no
high-grade focal stenosis. There is mild plaquing in its distal portion;
it bifurcates into left anterior descending artery and left circumflex
arteries.
3. LEFT ANTERIOR DESCENDING ARTERY: The left anterior descending artery has
mild disease in its proximal portion.

There are 3 diagonal branches. The proximal LAD has a smooth 20 percent
narrowing up to the origin of the first diagonal branch.

The first diagonal branch is a small-to-medium caliber vessel with mild
disease.

The second diagonal branch arises close to it with an ostial of 40 percent
stenosis.

The second diagonal branch is also a small-to-medium caliber vessel with
mild disease.

The third diagonal branch is a medium caliber vessel with ostial 60 percent
stenosis.

The mid left anterior descending artery involving the origin of the first to
third diagonal branch and just distal to this has a lesion with up to 80
percent stenosis just distal to the origin of the third diagonal branch and
a 40-50 percent stenosis between the first and third diagonal branches.




Mid LAD beyond this has mild disease. It is transapical. Distal LAD has mild
disease. It is a transapical vessel according to round the apex.

4. LEFT CIRCUMFLEX ARTERY: The left circumflex artery has mild disease in
its proximal portion with calcification and 30 percent stenosis in its
proximal portions. It gives rise to a medium-caliber first obtuse
marginal branch.

Mid left circumflex artery has 30-40 percent stenosis with a hazy stenosis
in the mid portion.

It gives rise to AV circumflex artery beyond the origin of the AV circumflex
artery. The mid circumflex artery has 80 percent hazy stenosis as it
bifurcates into second and third obtuse marginal branches. Both second and
third obtuse marginal branches are small-to-medium caliber vessel with mild
disease.

5. Right coronary artery: The right coronary artery is a dominant vessel.
Mild-to-moderate calcification noted in the proximal to mid right
coronary artery.

There is a 40 percent stenosis of the proximal right coronary artery
followed by another 40 percent stenosis in the midportion of the right
coronary artery and mild ectasia just distal to this.

Mid right coronary artery at the second bend has an eccentric 75 percent
stenosis. Distal to this right coronary artery is a mild diffuse disease. It
is a medium caliber vessel.

Distally it bifurcates into the posterolateral branch, which is a medium
caliber vessel with moderate disease distally and 3 posterolateral branches,
which have mild-to-moderate diffuse disease.

6. LEFT RENAL ARTERY: The left renal artery has mild disease with a 30
percent stenosis in the midportion.

7. RIGHT RENAL ARTERY: The right renal artery has mild disease without any
high-grade focal stenosis.

IMPRESSION:
1. Mild-to-moderate decreased left ventricular systolic function with
mild-to-moderate anterolateral and moderate anteroapical hypokinesis
with LVEF in the range of 45 percent with 2 plus mitral insufficiency.
Mild gradient across the aortic valve with near normal pulmonic arterial
wedge pressure and normal pulmonary arterial pressures.
2. Severe 3-vessel coronary artery disease with calcific 80 percent
stenosis of the mid LAD just beyond the origin of the diagonal branch;
50 percent stenosis of the ostial portion of the third diagonal branch;
80 percent stenosis of mid left circumflex artery just prior to its



bifurcation into the 2 obtuse marginal branches; 75 percent stenosis
with calcification of the mid right coronary artery.
3. Patent renal arteries bilaterally with mild disease.

RECOMMENDATIONS:
1. The patient has anteroapical and inferior wall ischemia, but there was
also significant lesion in the left circumflex artery.
2. Recommend further invasive interventional treatment with atherectomy
followed by angioplasty of the LAD and angioplasty of the diagonal
branch with stenting as needed as well as angioplasty of the mid left
circumflex artery. Consider elective atherectomy and angioplasty of the
right coronary artery in the future as a staged procedure.
3. _____ coronary artery disease.

What I come up with is 92928 LD, 92929, LC AND 36252. I'm just checking to make sure I have all the stents and angioplastys. Any help will do. Thanks


Hello,

You might consider these codes, diagnostic LT/RT cath. 93460-59, 36252, 92933-LD, 92929-LD, 92928-59-LC. I coded 92933, it said that the orbital atherectomy of the mid LAD was performed, then followed by stent and angioplasty, stent and angioplasty on 3rd diagonal branch, then stent and angioplasty on LC. Also since, they are utilizing DES, i think codes C9600-C9608 should be used instead of the 9 series.
 
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