Wiki Peripheral Coding HELP NEEDED

debbyallen

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Can someone help me to code this? This is definitely not my forte.


Procedures:
_x_Selective Coronary Angiography
_x_selctive angiogram of SVG to OM
_x_Selective angiogram of SVG to diag
_x_ selective angio of SVG to RCA
_x_ selective angio of LIMA to LAD
_x_attempted PCI to native LCX of instent restenosis but unable to cross with balloon
Access Site
_x_Left Radial Artery
_x_Right femoral Artery


EBL: 20 ml
Complications: none

Sedation:
Moderate Conscious Sedation was provided under my direct supervision with the sedation trained nurse using
_1_ Mg Versed
_25_ Meg Fentanyl
_o_ Mg of Diphenhydramine
Start time 1710 and end time was _1755 There were no complications.
See hospital trained nurses sedation sheet I signed and dated for completed pre and post service.

Anesthesia: Lidocaine 1% local

Procedure in detail :
I explained to the patient/family the indications, risks, benefits, and alternatives of the procedure. All questions were answered. Pt/family agrees to proceed.
The patient was brought to the Cardiac Catheterization Lab in a fasting state. All appropriate labs had been reviewed. Bilateral groins & wrists were prepped and draped in the usual fashion for sterile conditions. The appropriate time-out procedure was performed with appropriate identification of the patient, procedure, physician, position and documentation all done under my direct supervision and there were no safety issues raised by the staff.

The access area was anesthetized using Lidocaine. Using a modified Seldinger technique, the artery was cannulated and a sheath was inserted.
The left wrist was anesthetized using lidocaine 1%. The left radial artery was cannulated and a 6 French slender sheath was inserted. A 5 French JR4 catheter was then used to engage the right coronary ostium. Selective angiographic images were obtained. The catheter was then disengaged and then engaged into the vein graft to the right coronary ostium. Selective angiographic images were obtained. The catheter was then disengaged and exchanged for a 5 French JL 3.5 catheter. This is engage into the left coronary ostium. Selective angiographic images were obtained. The catheter was then disengaged and exchanged for a 5 French left coronary bypass catheter. This was engaged into the vein graft to the obtuse marginal. Selective antegrade graphic images were obtained.
The catheter was then exchanged for a 5 French internal mammary Cummings catheter. This was engaged into the left internal mammary artery. Selective angiography images were obtained. The catheter was then disengaged and then exchanged for a 5 French AL-1 catheter. This is engage into the vein graft to the diagonal. Selective angiographic images were obtained. The catheter was then removed. The images were reviewed and the decision was made to try to proceed with intervention to the native left circumflex. The patient is complaining of pain in his left wrist and so we decided to abort the left radial approach. The radial sheath was pulled and a pressure band was applied.

The right groin was anesthetized using lidocaine 1%. Right femoral artery was accessed and a 6 French sheath was inserted. A 6 French CLS 3.5 guiding catheter was then used to engage the left coronary ostium. A BMW wire is in used to cannulate into the distal left circumflex and into the second obtuse marginal. I then tried to take a balloon 2.5 x 15 and cross the in-stent restenosis but it would not cross. After several attempts I finally decided to abort the procedure. The patient was not having any chest pain. My suspicion is that the occlusion may be more chronic than acute. The outflow was very small and slow. Catheters were then removed. Right femoral and gram was done and showed the insertion site was in the right common femoral artery. Angio-Seal was then deployed in the right femoral artery. Good hemostasis was observed. Patient tolerated procedure well and is taken to the intensive care unit.

Closure Device: TR band

Findings:
Left Main distal left main 50%
LAD mild disease, competitive flow from LIMA
LCX moderate disease in native vessel, small caliber OM 1 small vessel
OM2 99% instent restenosis of prox stents, distally very small vessel, less than 1 mm RCA moderate diffuse disease
SVG to diagonal CLOSED
SVG to OM1 patent, prox graft 70% SVG RCA patent
LIMA to LAD patent

Dominance right

Lines: None Specimens: none Condition: serious IVF's: NS at 75 ml/hr

Post sedation Evaluation: Vital signs stable: yes Airway Reflexes present: yes
 
Dx codes: I25.10, T82.855
CPT - 93459 and 92920 with 53(physician) or 74(facility) modifier.
Append 26 modifier to 93459 if it is for physician coding. Hope this helps.
 
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