I STINK at cardiac coding and I really need some help with this, the HIM coder had on the abstract 92928 and 93458 and I believe it it wrong, but I keep coming up with different ones and am lost: (one of them was 93459 that I came up with):
PROCEDURES:
1. Left heart catheterization.
2. Coronary angiography.
3. Left ventriculography.
4. Percutaneous coronary intervention with drug-eluding stent placement to the
proximal to mid left anterior descending artery.
INDICATIONS: Recurrent unstable angina post prior stent placement at
HISTORY: This 46-year-old woman has a history of known coronary artery disease.
She had undergone PCI to the LAD in October 2012 and had a stress testing
performed in July 2013, which revealed no definite ischemia. In September 2013,
the patient presented to xxxx with recurrent and unstable angina and was found
to have a high-grade subtotal stenosis within the prior placement to the mid LAD
as well as anterior apical hypokinesis and with _____. She presented again to
xxxxxxx on 08/23/2013 with complaints of unstable angina and was
referred again for diagnostic study. Of note, ECG on admission does show
abnormal rate progression in V1 through V3 with preserved R waves laterally and
in V4 to V6 as well as nonspecific inferior ST changes.
FINDINGS:
1. Hemodynamics revealed aortic pressure of 170/70 with mean of 100. LV
pressure 170/70. Left ventriculography revealed reduced overall LDEF of
45% with anterolateral and apical hypokinesis noted.
2. Resting LVEDP with 17 mmHg.
3. Coronary angiography revealed significant obstructive coronary disease
noted in a left dominant system. The RCA with a small nondominant
diffusely diseased vessel. The left mainstem was a large caliber vessel
with no obstructive disease. The LAD with a small-to-moderate sized vessel
with a long stented area from the proximal to mid segment, the second 2/3
stented area had significantly stenosis tissue with a 95% stenosis noted in
the mid segment; however, with TIMI-3 flow. There was also a focal
high-grade stenosis noted at the distal stent edge. The diagonals were of
very small caliber. The left circumflex was a moderate caliber vessel,
which was dominant with mild plaquing and with no obstructive disease.
4. Following diagnostic study, a coronary intervention was performed, reducing
the initial 95% stenosis to 0% with continued TIMI-3 flow by initial
balloon angioplasty followed by preliminary 2.25 x 28 mm _____ stent, which
was dilated to 2.4 x 8 mm.
5. The patient tolerated the procedure without incident and there were no
complications.
PROCEDURES:
1. Left heart catheterization.
2. Coronary angiography.
3. Left ventriculography.
4. Percutaneous coronary intervention with drug-eluding stent placement to the
proximal to mid left anterior descending artery.
INDICATIONS: Recurrent unstable angina post prior stent placement at
HISTORY: This 46-year-old woman has a history of known coronary artery disease.
She had undergone PCI to the LAD in October 2012 and had a stress testing
performed in July 2013, which revealed no definite ischemia. In September 2013,
the patient presented to xxxx with recurrent and unstable angina and was found
to have a high-grade subtotal stenosis within the prior placement to the mid LAD
as well as anterior apical hypokinesis and with _____. She presented again to
xxxxxxx on 08/23/2013 with complaints of unstable angina and was
referred again for diagnostic study. Of note, ECG on admission does show
abnormal rate progression in V1 through V3 with preserved R waves laterally and
in V4 to V6 as well as nonspecific inferior ST changes.
FINDINGS:
1. Hemodynamics revealed aortic pressure of 170/70 with mean of 100. LV
pressure 170/70. Left ventriculography revealed reduced overall LDEF of
45% with anterolateral and apical hypokinesis noted.
2. Resting LVEDP with 17 mmHg.
3. Coronary angiography revealed significant obstructive coronary disease
noted in a left dominant system. The RCA with a small nondominant
diffusely diseased vessel. The left mainstem was a large caliber vessel
with no obstructive disease. The LAD with a small-to-moderate sized vessel
with a long stented area from the proximal to mid segment, the second 2/3
stented area had significantly stenosis tissue with a 95% stenosis noted in
the mid segment; however, with TIMI-3 flow. There was also a focal
high-grade stenosis noted at the distal stent edge. The diagonals were of
very small caliber. The left circumflex was a moderate caliber vessel,
which was dominant with mild plaquing and with no obstructive disease.
4. Following diagnostic study, a coronary intervention was performed, reducing
the initial 95% stenosis to 0% with continued TIMI-3 flow by initial
balloon angioplasty followed by preliminary 2.25 x 28 mm _____ stent, which
was dilated to 2.4 x 8 mm.
5. The patient tolerated the procedure without incident and there were no
complications.