For this procedure I have CPT code 93459-26. Would I use add on code +93567 for the non selective arch angio? Or am I wrong?
Help is appreciated!
PROCEDURES PERFORMED:
• Right common femoral angiography.
• Right coronary angiography.
• Left coronary angiography.
• Arch angiography.
• Left heart catheterization with angiography.
• Saphenous vein graft angiography.
SUMMARY:
1. Left ventricle: Wall motion is normal; there are no regional wall motion abnormalities.
2. Left main: Distal vessel lesion: There is a 50% stenosis.
3. LAD: Proximal vessel lesion: There is an 85% stenosis. Midvessel
lesion: There is a 100% stenosis.
4. Right coronary: Lesion: There is a mid 95% stenosis. Proximal vessel lesion: There is a 70% stenosis.
5. Right posterior descending: Proximal vessel lesion: There is a 90% stenosis.
6. Peripheral vascular disease unable
to deliver wires/catheters via femoral artery approach due to tortuosity and
significant vascular disease in distal abdominal aorta and iliac arteries. Would recommend CTA abdomen with runoff
to further evaluate.
7. Unable to deliver SWAN GANZ to RV/PA/PCW.
8. There was a mild gradient from LV to Ao on pullback (was able to deliver catheter). I suspect the aortic valve stenosis
is not severe as per echocardiogram.
PROCEDURE:
1. Initial setup. The patient was brought to the laboratory. Surface ECG leads, blood pressure measurements, and
pulse oximetric signals were monitored.
2. Skin preparation. The planned puncture sites were clipped, prepped, and draped in the usual sterile manner.
3. Local anesthesia. 1% Lidocaine was administered to the access site.
4. Right femoral vein access. A 6F x 11cm Prelude Pro sheath was advanced into the vessel.
5. Right femoral artery access. A 6F x 11cm Prelude Pro sheath was advanced into the vessel.
6. Selective right common femoral angiography, under fluoroscopic guidance. A catheter was advanced into the right
common femoral artery. Contrast was injected by hand. Images were obtained.
7. Right radial artery access. A 6f Glidesheath Slender sheath was advanced into the vessel.
8. Selective right coronary angiography. A 6F WR Expo 100cm catheter was advanced into the right coronary vessel
ostium under fluoroscopic guidance. Contrast was injected. Images were obtained in multiple projections.
9. Selective left coronary angiography. A 6F FL3.5 Expo 100cm catheter was advanced into the left coronary vessel
ostium under fluoroscopic guidance. Contrast was injected. Images were obtained in multiple projections.
10. Nonselective arch angiography, under fluoroscopic guidance. A 6F Pig 145 EXPO 110CM catheter was advanced
to the aortic root. Contrast was injected. Images were obtained.
11. Left heart catheterization with angiography. A 6F LCB Expo 100cm catheter was advanced across the aortic valve to
the left ventricle under fluoroscopic guidance. 20 ml of contrast was injected at 10 ml/s.
12. Selective angiography of the saphenous vein graft to the 1st obtuse marginal. A 6F LCB Expo 100cm catheter was
advanced into the saphenous vein graft proximal anastomosis under fluoroscopic guidance. Contrast was injected.
Images were obtained in multiple projections.
13. Right radial artery hemostasis. Mechanical compression was applied.
14. Right femoral artery hemostasis. Mechanical compression was applied.
15. Right femoral vein hemostasis. Manual compression was applied.
CORONARY ARTERIES: The coronary circulation is right dominant.
Left main: Distal vessel lesion: There is a 50% stenosis.
LAD: Proximal vessel lesion: There is an 85% stenosis. Midvessel
lesion: There is a 100% stenosis.
Right coronary: Lesion: There is a mid 95% stenosis. Proximal vessel lesion: There is a 70% stenosis.
Right posterior descending: Proximal vessel lesion: There is a 90% stenosis.
CORONARY GRAFTS:
Saphenous vein graft to the 1st obtuse marginal, from the aorta: Patent.
LIMA graft to the distal LAD: Present. Nonselective angio confirmed patency of LIMA to LAD. There is competitive flow
noted in LAD.
LEFT VENTRICLE: Wall motion is normal; there are no regional wall motion abnormalities. Wall motion score: 1.00.
Help is appreciated!
PROCEDURES PERFORMED:
• Right common femoral angiography.
• Right coronary angiography.
• Left coronary angiography.
• Arch angiography.
• Left heart catheterization with angiography.
• Saphenous vein graft angiography.
SUMMARY:
1. Left ventricle: Wall motion is normal; there are no regional wall motion abnormalities.
2. Left main: Distal vessel lesion: There is a 50% stenosis.
3. LAD: Proximal vessel lesion: There is an 85% stenosis. Midvessel
lesion: There is a 100% stenosis.
4. Right coronary: Lesion: There is a mid 95% stenosis. Proximal vessel lesion: There is a 70% stenosis.
5. Right posterior descending: Proximal vessel lesion: There is a 90% stenosis.
6. Peripheral vascular disease unable
to deliver wires/catheters via femoral artery approach due to tortuosity and
significant vascular disease in distal abdominal aorta and iliac arteries. Would recommend CTA abdomen with runoff
to further evaluate.
7. Unable to deliver SWAN GANZ to RV/PA/PCW.
8. There was a mild gradient from LV to Ao on pullback (was able to deliver catheter). I suspect the aortic valve stenosis
is not severe as per echocardiogram.
PROCEDURE:
1. Initial setup. The patient was brought to the laboratory. Surface ECG leads, blood pressure measurements, and
pulse oximetric signals were monitored.
2. Skin preparation. The planned puncture sites were clipped, prepped, and draped in the usual sterile manner.
3. Local anesthesia. 1% Lidocaine was administered to the access site.
4. Right femoral vein access. A 6F x 11cm Prelude Pro sheath was advanced into the vessel.
5. Right femoral artery access. A 6F x 11cm Prelude Pro sheath was advanced into the vessel.
6. Selective right common femoral angiography, under fluoroscopic guidance. A catheter was advanced into the right
common femoral artery. Contrast was injected by hand. Images were obtained.
7. Right radial artery access. A 6f Glidesheath Slender sheath was advanced into the vessel.
8. Selective right coronary angiography. A 6F WR Expo 100cm catheter was advanced into the right coronary vessel
ostium under fluoroscopic guidance. Contrast was injected. Images were obtained in multiple projections.
9. Selective left coronary angiography. A 6F FL3.5 Expo 100cm catheter was advanced into the left coronary vessel
ostium under fluoroscopic guidance. Contrast was injected. Images were obtained in multiple projections.
10. Nonselective arch angiography, under fluoroscopic guidance. A 6F Pig 145 EXPO 110CM catheter was advanced
to the aortic root. Contrast was injected. Images were obtained.
11. Left heart catheterization with angiography. A 6F LCB Expo 100cm catheter was advanced across the aortic valve to
the left ventricle under fluoroscopic guidance. 20 ml of contrast was injected at 10 ml/s.
12. Selective angiography of the saphenous vein graft to the 1st obtuse marginal. A 6F LCB Expo 100cm catheter was
advanced into the saphenous vein graft proximal anastomosis under fluoroscopic guidance. Contrast was injected.
Images were obtained in multiple projections.
13. Right radial artery hemostasis. Mechanical compression was applied.
14. Right femoral artery hemostasis. Mechanical compression was applied.
15. Right femoral vein hemostasis. Manual compression was applied.
CORONARY ARTERIES: The coronary circulation is right dominant.
Left main: Distal vessel lesion: There is a 50% stenosis.
LAD: Proximal vessel lesion: There is an 85% stenosis. Midvessel
lesion: There is a 100% stenosis.
Right coronary: Lesion: There is a mid 95% stenosis. Proximal vessel lesion: There is a 70% stenosis.
Right posterior descending: Proximal vessel lesion: There is a 90% stenosis.
CORONARY GRAFTS:
Saphenous vein graft to the 1st obtuse marginal, from the aorta: Patent.
LIMA graft to the distal LAD: Present. Nonselective angio confirmed patency of LIMA to LAD. There is competitive flow
noted in LAD.
LEFT VENTRICLE: Wall motion is normal; there are no regional wall motion abnormalities. Wall motion score: 1.00.