amym
Guest
Is it appropriate to code this as 93460-26?
PROCEDURES PERFORMED:
-- Right heart catheterization.
-- Left heart catheterization.
-- Left coronary angiography.
-- Right coronary angiography.
-- Quick Clot Closure.
-- Quick Clot Closure.
DISPOSITION: The patient left the catheterization laboratory in stable
condition. The patient will be discharged on the day of the procedure,
following bed rest and subsequent ambulation, provided the recovery
parameters are appropriate. The patient has been instructed to call the
procedural cardiologist immediately if symptoms recur, or should there be
any problems with the puncture site, such as bleeding, swelling, pain or
signs of infection.
INDICATIONS: Cardiac: aortic valve disease. BICUSPID AV, SEVERE AS, PREOP
PRIOR TO AVR
HEMODYNAMICS: Hemodynamic assessment demonstrates normal cardiac output
and mildly elevated pulmonary capillary wedge pressure. There is mild
pulmonary hypertension.
VENTRICLES: NO LV GRAM PERFORMED. DID NOT CROSS THE HEAVILY CALCIFIED AND STENOTIC BICUSPID AV.
CORONARY VESSELS: The coronary circulation is right dominant. Coronary
angiography demonstrated minor luminal irregularities. Left main: Normal.
LAD: Angiography showed minor luminal irregularities. Circumflex:
Angiography showed minor luminal irregularities. RCA: Angiography showed
minor luminal irregularities.
PROCEDURE: The risks and alternatives of the procedures and conscious
sedation were explained to the patient and informed consent was obtained.
The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile
fashion.
-- Right femoral artery access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Right femoral vein access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Right heart catheterization. A catheter was advanced to the pulmonary
artery wedge position.
-- Left heart catheterization. A catheter was advanced to the ascending
aorta. After recording ascending aortic pressure, the catheter was
advanced across the aortic valve and left ventricular pressure was
recorded. Imaging was performed using an RAO projection.
-- Left coronary artery angiography. A catheter was advanced to the aorta
and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Right coronary artery angiography. A catheter was advanced to the
aorta and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Quick Clot Closure..
-- Quick Clot Closure..
STUDY DIAGRAM
HEMODYNAMIC TABLES
Pressures: Baseline
Pressures: - HR: 68
Pressures: - Rhythm:
Pressures: -- Aortic Pressure (S/D/M): 123/69/78
Pressures: -- Pulmonary Artery (S/D/M): 31/15/21
Pressures: -- Pulmonary Capillary Wedge: 18/15/14
Pressures: -- Right Atrium (a/v/M): 12/9/7
Pressures: -- Right Ventricle (s/edp): 34/12/--
O2 Sats: Baseline
O2 Sats: - HR: 68
O2 Sats: - Rhythm:
O2 Sats: -- AO: 13.1/95/17.15
O2 Sats: -- PA: 13.1/72/12.94
Outputs: Baseline
Outputs: -- CALCULATIONS: Age in years: 70.16
Outputs: -- CALCULATIONS: Average Partial Oxygen - PA: 40.00
Outputs: -- CALCULATIONS: Average Partial Oxygen - SA: 78.00
Outputs: -- CALCULATIONS: Body Surface Area: 2.32
Outputs: -- CALCULATIONS: Height in cm: 191.00
Outputs: -- CALCULATIONS: Sex: Male
Outputs: -- CALCULATIONS: Weight in kg: 103.00
Outputs: -- OUTPUTS: CO by Fick: 6.30
Outputs: -- OUTPUTS: Fick cardiac index: 2.71
Outputs: -- OUTPUTS: Fick HR: 66.00
Outputs: -- OUTPUTS: O2 consumption: 265.01
Outputs: -- OUTPUTS: Vo2 Indexed: 114.21
Outputs: -- RESISTANCES: Left ventricular stroke work: 81.79
Outputs: -- RESISTANCES: Left Ventricular Stroke Work index: 35.25
Outputs: -- RESISTANCES: Pulmonary vascular index (dsc): 206.34
Outputs: -- RESISTANCES: Pulmonary vascular index (Wood Units): 2.58
Outputs: -- RESISTANCES: Pulmonary vascular resistance (dsc): 88.92
Outputs: -- RESISTANCES: Pulmonary vascular resistance (Wood Units): 1.11
Outputs: -- RESISTANCES: PVR_SVR Ratio: 0.10
Outputs: -- RESISTANCES: Right ventricular stroke work: 17.63
Outputs: -- RESISTANCES: Right ventricular stroke work index: 7.60
Outputs: -- RESISTANCES: Systemic vascular index (dsc): 2092.88
Outputs: -- RESISTANCES: Systemic vascular index (Wood Units): 26.17
Outputs: -- RESISTANCES: Systemic vascular resistance (dsc): 901.93
Outputs: -- RESISTANCES: Systemic vascular resistance (Wood Units): 11.28
Outputs: -- RESISTANCES: Total pulmonary index (dsc): 619.02
Outputs: -- RESISTANCES: Total pulmonary index (Wood Units): 7.74
Outputs: -- RESISTANCES: Total pulmonary resistance (dsc): 266.77
Outputs: -- RESISTANCES: Total pulmonary resistance (Wood Units): 3.34
Outputs: -- RESISTANCES: Total vascular index (Wood Units): 28.75
Outputs: -- RESISTANCES: Total vascular resistance (dsc): 990.85
Outputs: -- RESISTANCES: Total vascular resistance (Wood Units): 12.39
Outputs: -- RESISTANCES: Total vascular resistance index (dsc): 2299.22
Outputs: -- RESISTANCES: TPR_TVR Ratio: 0.27
Outputs: -- SHUNTS: Pulmonary flow: 6.30
Outputs: -- SHUNTS: Qp Indexed: 2.71
Outputs: -- SHUNTS: Qs Indexed: 2.71
Outputs: -- SHUNTS: Systemic flow: 6.30
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PROCEDURES PERFORMED:
-- Right heart catheterization.
-- Left heart catheterization.
-- Left coronary angiography.
-- Right coronary angiography.
-- Quick Clot Closure.
-- Quick Clot Closure.
DISPOSITION: The patient left the catheterization laboratory in stable
condition. The patient will be discharged on the day of the procedure,
following bed rest and subsequent ambulation, provided the recovery
parameters are appropriate. The patient has been instructed to call the
procedural cardiologist immediately if symptoms recur, or should there be
any problems with the puncture site, such as bleeding, swelling, pain or
signs of infection.
INDICATIONS: Cardiac: aortic valve disease. BICUSPID AV, SEVERE AS, PREOP
PRIOR TO AVR
HEMODYNAMICS: Hemodynamic assessment demonstrates normal cardiac output
and mildly elevated pulmonary capillary wedge pressure. There is mild
pulmonary hypertension.
VENTRICLES: NO LV GRAM PERFORMED. DID NOT CROSS THE HEAVILY CALCIFIED AND STENOTIC BICUSPID AV.
CORONARY VESSELS: The coronary circulation is right dominant. Coronary
angiography demonstrated minor luminal irregularities. Left main: Normal.
LAD: Angiography showed minor luminal irregularities. Circumflex:
Angiography showed minor luminal irregularities. RCA: Angiography showed
minor luminal irregularities.
PROCEDURE: The risks and alternatives of the procedures and conscious
sedation were explained to the patient and informed consent was obtained.
The patient was brought to the cath lab and placed on the table. The
planned puncture sites were prepped and draped in the usual sterile
fashion.
-- Right femoral artery access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Right femoral vein access. The puncture site was infiltrated with
local anesthetic. The vessel was accessed using the modified Seldinger
technique, a wire was threaded into the vessel, and a sheath was advanced
over the wire into the vessel.
-- Right heart catheterization. A catheter was advanced to the pulmonary
artery wedge position.
-- Left heart catheterization. A catheter was advanced to the ascending
aorta. After recording ascending aortic pressure, the catheter was
advanced across the aortic valve and left ventricular pressure was
recorded. Imaging was performed using an RAO projection.
-- Left coronary artery angiography. A catheter was advanced to the aorta
and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Right coronary artery angiography. A catheter was advanced to the
aorta and positioned in the vessel ostium under fluoroscopic guidance.
Angiography was performed in multiple projections using hand-injection of
contrast.
-- Quick Clot Closure..
-- Quick Clot Closure..
STUDY DIAGRAM
HEMODYNAMIC TABLES
Pressures: Baseline
Pressures: - HR: 68
Pressures: - Rhythm:
Pressures: -- Aortic Pressure (S/D/M): 123/69/78
Pressures: -- Pulmonary Artery (S/D/M): 31/15/21
Pressures: -- Pulmonary Capillary Wedge: 18/15/14
Pressures: -- Right Atrium (a/v/M): 12/9/7
Pressures: -- Right Ventricle (s/edp): 34/12/--
O2 Sats: Baseline
O2 Sats: - HR: 68
O2 Sats: - Rhythm:
O2 Sats: -- AO: 13.1/95/17.15
O2 Sats: -- PA: 13.1/72/12.94
Outputs: Baseline
Outputs: -- CALCULATIONS: Age in years: 70.16
Outputs: -- CALCULATIONS: Average Partial Oxygen - PA: 40.00
Outputs: -- CALCULATIONS: Average Partial Oxygen - SA: 78.00
Outputs: -- CALCULATIONS: Body Surface Area: 2.32
Outputs: -- CALCULATIONS: Height in cm: 191.00
Outputs: -- CALCULATIONS: Sex: Male
Outputs: -- CALCULATIONS: Weight in kg: 103.00
Outputs: -- OUTPUTS: CO by Fick: 6.30
Outputs: -- OUTPUTS: Fick cardiac index: 2.71
Outputs: -- OUTPUTS: Fick HR: 66.00
Outputs: -- OUTPUTS: O2 consumption: 265.01
Outputs: -- OUTPUTS: Vo2 Indexed: 114.21
Outputs: -- RESISTANCES: Left ventricular stroke work: 81.79
Outputs: -- RESISTANCES: Left Ventricular Stroke Work index: 35.25
Outputs: -- RESISTANCES: Pulmonary vascular index (dsc): 206.34
Outputs: -- RESISTANCES: Pulmonary vascular index (Wood Units): 2.58
Outputs: -- RESISTANCES: Pulmonary vascular resistance (dsc): 88.92
Outputs: -- RESISTANCES: Pulmonary vascular resistance (Wood Units): 1.11
Outputs: -- RESISTANCES: PVR_SVR Ratio: 0.10
Outputs: -- RESISTANCES: Right ventricular stroke work: 17.63
Outputs: -- RESISTANCES: Right ventricular stroke work index: 7.60
Outputs: -- RESISTANCES: Systemic vascular index (dsc): 2092.88
Outputs: -- RESISTANCES: Systemic vascular index (Wood Units): 26.17
Outputs: -- RESISTANCES: Systemic vascular resistance (dsc): 901.93
Outputs: -- RESISTANCES: Systemic vascular resistance (Wood Units): 11.28
Outputs: -- RESISTANCES: Total pulmonary index (dsc): 619.02
Outputs: -- RESISTANCES: Total pulmonary index (Wood Units): 7.74
Outputs: -- RESISTANCES: Total pulmonary resistance (dsc): 266.77
Outputs: -- RESISTANCES: Total pulmonary resistance (Wood Units): 3.34
Outputs: -- RESISTANCES: Total vascular index (Wood Units): 28.75
Outputs: -- RESISTANCES: Total vascular resistance (dsc): 990.85
Outputs: -- RESISTANCES: Total vascular resistance (Wood Units): 12.39
Outputs: -- RESISTANCES: Total vascular resistance index (dsc): 2299.22
Outputs: -- RESISTANCES: TPR_TVR Ratio: 0.27
Outputs: -- SHUNTS: Pulmonary flow: 6.30
Outputs: -- SHUNTS: Qp Indexed: 2.71
Outputs: -- SHUNTS: Qs Indexed: 2.71
Outputs: -- SHUNTS: Systemic flow: 6.30
476212
