Kcronin1122
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Hi all,
I am really stuggling with coding this procedure. Any help would be appreciated.
Description of Procedure:
The procedure included a right and left heart catheterization
with oximetry and hemodynamics, thermodilution calculation of
cardiac output, bilateral coronary angiography, and angioplasty
of the superior vena cava.
LUCY was brought to the cardiac catheterization lab. After all
consents were checked and the hold points completed, she was
placed in the usual position and was placed under moderate
sedation by the anesthesia team. The access site was prepared in
the usual sterile manner. Vascular ultrasound imaging was
utilized to define selected vessel patency. Real-time imaging
was used during vascular access attempts, including visualization
of needle passage into the vessel lumen, due to need minimize
vascular complications. Ultrasound imaging was captured and
placed in the medical record. Access was obtained using the
Seldinger technique in the right femoral vein with a 6 French
sheath and the right femoral artery with a 5 French sheath. After
access was obtained and sheaths were placed, a 5 French pigtail
catheter and a 6 French Wedge catheter were utilized to perform
hemodynamic measurements. There was a 2 mmHg gradient across the
SVC and we were unable to enter the innominate vein so the wedge
catheter was used to perform a wedge angiogram in the SVC which
demonstrated an occluded innominate vein and moderate
angiographic stenosis of the SVC. The Wedge was removed and a
6F thermodilution was advanced into the RPA. After baseline
hemodynamics and oximetry were obtained, thermodilution cardiac
output was performed using 10 ml of cold saline x3.
The thermodilution catheter was then removed and the short venous
sheath was exchanged for a 6 French Mullins. The Mullins sheath
was used to direct a Bioptome for biopsy specimens from the RV
apex. 5 biopsy specimens were taken without complication.
After the biopsy samples were obtained, selective coronary
angiography was completed by replacing the pigtail catheter with
a JL3.5 catheter, which was advanced to the os of the left main
coronary artery. 3 hand injections of contrast were performed.
The left coronary catheter was then replaced with an AR mod
catheter. The right coronary artery os was engaged and 1 hand
injection was performed.
We then proceeded with angioplasty of the SVC. A 0.035"
J-exchange wire was advanced into the right subclavian vein. The
6F short sheath was exchanged for a 7F short sheath. A 12 mm x 4
cm Powerflex balloon was advanced into the SVC and 2 inflations
were performed to 9 and 10 atm with an 8 mm residual waist noted
on balloon. The Powerflex balloon was removed and a 12 mm x 2 cm
Atlas Gold balloon was advanced across the stenosis and inflated
to 18 atm with resolution of the waist. The balloon was removed
and a 7F cut pigtail was used to perform an angiogram with mild
residual stenosis. This concluded the case.
After completion of the procedure, local anesthesia was given at
the access site. The sheaths were removed and hemostasis was
obtained. LUCY was awoken and transferred to the PACU in stable
condition. The estimated blood loss was 15 mL (11 mL from blood
draw). The total fluoroscopy was DAP 45.3 Gycm2 and Air Kerma
382.17 mgy. 37 ml of contrast were given in total. A total of 0
units of IV heparin were given throughout the case.
There were no complications.
Catheterization Findings:
Qp = 5.40 L/min (3.22 L/min/m2)
Qs = 5.40 L/min (3.22 L/min/m2)
Rp = 1.11 units (1.87 units x m2)
Rs = 16.28 units (27.36 units x m2)
Qp/Qs = 1.00 : 1 | Rp/Rs = 0.07
Angiography:
1: SVC (6F Wedge, AP/Lat projections): There is moderate
stenosis of the superior vena cava. The innominate vein is
occluded with no residual flow from the left subclavian and left
jugular vein.
2: Left coronary artery.
Three hand injections of contrast were performed through a JL3.5
catheter at the left coronary os. The left coronary artery
appears normal with no evidence of stenosis, narrowing or
bridging. There is normal blush phase and the coronary sinus
appears normal without stenosis.
3: Right coronary artery
Two hand injections of contrast were performed through an ARmod
catheter within the right coronary artery os. The right coronary
artery appears normal with no evidence of stenosis, narrowing or
bridging. There is normal blush phase and the coronary sinus
appears normal without stenosis.
4: SVC following angioplasty with 12 mm x 2 cm Atlas Gold balloon
(7F cut pigtail, AP/Lat projections): There is mild residual
stenois of the SVC with no intimal injury.
Impression:
LUCY is a 17 year old female s/p orthotopic heart
transplant for failed 2 ventricle repair.
1. Normal RVEDP (8 mmHg)
2. Normal mPA pressure (17 mmHg)
3. Elevated LVEDP (14 mmHg)
4. Normal cardiac index (thermodilution 4.33 L/min)
5. Normal PVR (1.9 iWU)
6. Biopsies pending
7. Normal coronary angiography
8. Moderate IVC stenosis
A. S/p angioplasty with 12 mm Atlas Gold balloon
B. 1 mmHg residual gradient
9. Occlusion of innominate vein, left jugular vein, and left
subclavian vein
I am really stuggling with coding this procedure. Any help would be appreciated.
Description of Procedure:
The procedure included a right and left heart catheterization
with oximetry and hemodynamics, thermodilution calculation of
cardiac output, bilateral coronary angiography, and angioplasty
of the superior vena cava.
LUCY was brought to the cardiac catheterization lab. After all
consents were checked and the hold points completed, she was
placed in the usual position and was placed under moderate
sedation by the anesthesia team. The access site was prepared in
the usual sterile manner. Vascular ultrasound imaging was
utilized to define selected vessel patency. Real-time imaging
was used during vascular access attempts, including visualization
of needle passage into the vessel lumen, due to need minimize
vascular complications. Ultrasound imaging was captured and
placed in the medical record. Access was obtained using the
Seldinger technique in the right femoral vein with a 6 French
sheath and the right femoral artery with a 5 French sheath. After
access was obtained and sheaths were placed, a 5 French pigtail
catheter and a 6 French Wedge catheter were utilized to perform
hemodynamic measurements. There was a 2 mmHg gradient across the
SVC and we were unable to enter the innominate vein so the wedge
catheter was used to perform a wedge angiogram in the SVC which
demonstrated an occluded innominate vein and moderate
angiographic stenosis of the SVC. The Wedge was removed and a
6F thermodilution was advanced into the RPA. After baseline
hemodynamics and oximetry were obtained, thermodilution cardiac
output was performed using 10 ml of cold saline x3.
The thermodilution catheter was then removed and the short venous
sheath was exchanged for a 6 French Mullins. The Mullins sheath
was used to direct a Bioptome for biopsy specimens from the RV
apex. 5 biopsy specimens were taken without complication.
After the biopsy samples were obtained, selective coronary
angiography was completed by replacing the pigtail catheter with
a JL3.5 catheter, which was advanced to the os of the left main
coronary artery. 3 hand injections of contrast were performed.
The left coronary catheter was then replaced with an AR mod
catheter. The right coronary artery os was engaged and 1 hand
injection was performed.
We then proceeded with angioplasty of the SVC. A 0.035"
J-exchange wire was advanced into the right subclavian vein. The
6F short sheath was exchanged for a 7F short sheath. A 12 mm x 4
cm Powerflex balloon was advanced into the SVC and 2 inflations
were performed to 9 and 10 atm with an 8 mm residual waist noted
on balloon. The Powerflex balloon was removed and a 12 mm x 2 cm
Atlas Gold balloon was advanced across the stenosis and inflated
to 18 atm with resolution of the waist. The balloon was removed
and a 7F cut pigtail was used to perform an angiogram with mild
residual stenosis. This concluded the case.
After completion of the procedure, local anesthesia was given at
the access site. The sheaths were removed and hemostasis was
obtained. LUCY was awoken and transferred to the PACU in stable
condition. The estimated blood loss was 15 mL (11 mL from blood
draw). The total fluoroscopy was DAP 45.3 Gycm2 and Air Kerma
382.17 mgy. 37 ml of contrast were given in total. A total of 0
units of IV heparin were given throughout the case.
There were no complications.
Catheterization Findings:
Qp = 5.40 L/min (3.22 L/min/m2)
Qs = 5.40 L/min (3.22 L/min/m2)
Rp = 1.11 units (1.87 units x m2)
Rs = 16.28 units (27.36 units x m2)
Qp/Qs = 1.00 : 1 | Rp/Rs = 0.07
Angiography:
1: SVC (6F Wedge, AP/Lat projections): There is moderate
stenosis of the superior vena cava. The innominate vein is
occluded with no residual flow from the left subclavian and left
jugular vein.
2: Left coronary artery.
Three hand injections of contrast were performed through a JL3.5
catheter at the left coronary os. The left coronary artery
appears normal with no evidence of stenosis, narrowing or
bridging. There is normal blush phase and the coronary sinus
appears normal without stenosis.
3: Right coronary artery
Two hand injections of contrast were performed through an ARmod
catheter within the right coronary artery os. The right coronary
artery appears normal with no evidence of stenosis, narrowing or
bridging. There is normal blush phase and the coronary sinus
appears normal without stenosis.
4: SVC following angioplasty with 12 mm x 2 cm Atlas Gold balloon
(7F cut pigtail, AP/Lat projections): There is mild residual
stenois of the SVC with no intimal injury.
Impression:
LUCY is a 17 year old female s/p orthotopic heart
transplant for failed 2 ventricle repair.
1. Normal RVEDP (8 mmHg)
2. Normal mPA pressure (17 mmHg)
3. Elevated LVEDP (14 mmHg)
4. Normal cardiac index (thermodilution 4.33 L/min)
5. Normal PVR (1.9 iWU)
6. Biopsies pending
7. Normal coronary angiography
8. Moderate IVC stenosis
A. S/p angioplasty with 12 mm Atlas Gold balloon
B. 1 mmHg residual gradient
9. Occlusion of innominate vein, left jugular vein, and left
subclavian vein