PTCA of the LAD, Left heart cath..Assistance appreciated

CodeProAl

Contributor
Messages
10
Location
Florence AL
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0
Procedure:
Left heart cath, PTCA of LAD. I used AngioJet, and Export thrombectomy catheter. we stented the LAD and eventually an Impella device was put in.

Indication: Acute myocardial infarction

Procedure Description: Patient was prepped and draped in a sterile fashion. Access was gained via the right radial artery. A 6-French sheath was placed. A 6-French diagnostic catheter was used. A catheter was placed across the aortic valve. LV pressure was 114/12. Pullback pressure was 97/70. Next, the right coronary artery was cannulated. The right coronary artery was nonobstructive. Next, left main coronary artery was cannulated. Left main coronary artery was cannulated with a 6-French XBLAD guide. Circumflex was nonobstructive. LAD was occluded proximally. We used a BMW wire and a 2.5 x 20 balloon. Miraculously, we were able to cross the lesion in the LAD. There was poor flow distally and it appeared a large thrombus was present in its proximal segment. We used the Export catheter to reduce the thrombus burden. Next, we wanted to use AngioJet. The AngioJet failed and a decision was made, we did go up with the balloon proximally, then a decision was made to use AngioJet. The AngioJet machine failed and the patient was continuously infarcting and in severe pain. We decided to stent the lesion. A 4.0x23 mm stent was used and deployed. Residual stenosis was zero, but the rest of the vessel did shut down distally. Next, we got the Jetstream active. We were able to Jetstream the entire vessel and again there was poor flow distally. An attempt was made to use adenosine. At this point, the patient became unresponsive. He stopped breathing and CPR was done. Blood pressure and heart rate and pulse was restored. Subsequently, an Impella device was placed in the left ventricle. That procedure went well with the Impella device. The patient was intubated during this whole procedure as well. At the end of the procedure, his heart rate was 120, BP 90/69. He is on pressor agents, 1mcg of neo and he will be transported to the ICU. His prognosis is extremely guarded. He is in pulmonary edema. We will try to optimize his medication and hopefully he will survive this infarct.
 

Jim Pawloski

True Blue
Messages
1,390
Location
Ann Arbor
Best answers
1
Procedure:
Left heart cath, PTCA of LAD. I used AngioJet, and Export thrombectomy catheter. we stented the LAD and eventually an Impella device was put in.

Indication: Acute myocardial infarction

Procedure Description: Patient was prepped and draped in a sterile fashion. Access was gained via the right radial artery. A 6-French sheath was placed. A 6-French diagnostic catheter was used. A catheter was placed across the aortic valve. LV pressure was 114/12. Pullback pressure was 97/70. Next, the right coronary artery was cannulated. The right coronary artery was nonobstructive. Next, left main coronary artery was cannulated. Left main coronary artery was cannulated with a 6-French XBLAD guide. Circumflex was nonobstructive. LAD was occluded proximally. We used a BMW wire and a 2.5 x 20 balloon. Miraculously, we were able to cross the lesion in the LAD. There was poor flow distally and it appeared a large thrombus was present in its proximal segment. We used the Export catheter to reduce the thrombus burden. Next, we wanted to use AngioJet. The AngioJet failed and a decision was made, we did go up with the balloon proximally, then a decision was made to use AngioJet. The AngioJet machine failed and the patient was continuously infarcting and in severe pain. We decided to stent the lesion. A 4.0x23 mm stent was used and deployed. Residual stenosis was zero, but the rest of the vessel did shut down distally. Next, we got the Jetstream active. We were able to Jetstream the entire vessel and again there was poor flow distally. An attempt was made to use adenosine. At this point, the patient became unresponsive. He stopped breathing and CPR was done. Blood pressure and heart rate and pulse was restored. Subsequently, an Impella device was placed in the left ventricle. That procedure went well with the Impella device. The patient was intubated during this whole procedure as well. At the end of the procedure, his heart rate was 120, BP 90/69. He is on pressor agents, 1mcg of neo and he will be transported to the ICU. His prognosis is extremely guarded. He is in pulmonary edema. We will try to optimize his medication and hopefully he will survive this infarct.

I would code this 93458 for the left heart, 92941 for the stent in the LAD, 33990 for the Impella, and 92950 for the CPR.
HTH,
Jim Pawloski, CIRCC
 
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