sslater
Networker
I am making sure i haven't missed anything in the following cath report.. i have 93460-26 and 93567. Are there any other add on codes for the pressures, cardiac output and thermodilution that i'm missing or are they included in the cath codes already?
Thanks.. i don't get the R/L Caths a lot so i just wanted to double check!!
PROCEDURE: Left and right heart catheterization with selective
coronary arteriography, left ventriculography, distal aortic root
shot.
A. DYE USED: Less than 100 cc's of dye.
B. COMPLICATIONS: No acute or apparent complications.
C. PREMEDICATIONS: 25mg of p.o. Benadryl and 5mg of p.o.
Valium.
D. TECHNIQUE: Modified Seldinger technique through the right
femoral artery and right femoral vein.
E. CATHETERS: 5 French sheath in right femoral artery, 7
French sheath in the right femoral vein with 7 French Swan-
Ganz catheter. JL4 and JR4 were noted and 5 French pigtail
were used.
PRESSURES/SATURATIONS: IVC saturation was 78. SVG 65, PA 70, high
RA 71.8, RV 69.5. AO 99%. No apparent shunting was identified on
the right side.
Cardiac output and index using thermodilution were 4.5 and 2.6.
Pressures were noted. Aortic pressure was 130/80. LV was
129/17. EDP was normal. No apparent aortic valve gradient was
noted. RA mean pressure was 4. RV was 20/4. PA pressure was
about 20/10. Right sided pressures were relatively within normal
limits.
ANGIOGRAMS:
A. LEFT MAIN: Left main coronary artery had a normal
arteriogram.
B. LEFT ANTERIOR DESCENDING: The LAD had a 20-30%
irregularities throughout its course. Some calicification.
First diagonal was a moderate calibered vessel and had a normal arteriogram.
C. CIRCUMFLEX: The circumflex artery was a moderate calibered
vessel artery. It gave rise to an OM1, which was moderate
and had 20-30% irregularities. OM2 was moderate and had 20-
30% irregularities.
D. RAMUS INTERMEDIUS BRANCH: Ramus intermedius branch was a
moderate calibered vessel artery. It had 20-30%
irregularities.
E. RIGHT CORONARY ARTERY: RCA was dominant. It had 20%
irregularities. PDA was a moderate calibered vessel artery
and had a normal arteriogram. PL branch was a moderate
calibered vessel artery and had a normal arteriogram.
LEFT VENTRICULAR: LV was visualized in RAO projection. EF was
estimated at 60%. Plus 1 MR was noted. Volumes were within
normal limits.
DISTAL AORTIC ROOT SHOT: Distal aortic root looked at the renal
arteries non-selectively, which did not have any significant
disease. 20-30% irregularities were noted in the left renal
artery.
IMPRESSION:
1. Right-sided pressures were normal. No apparent shunting
was noted on the right side. Cardiac output index was
normal. LVEF was normal. Plus 1 MR is noted. Coronaries
had 20-30% irregularities in the left system and right
system.
2. Renals did not have any significant disease
Thanks.. i don't get the R/L Caths a lot so i just wanted to double check!!
PROCEDURE: Left and right heart catheterization with selective
coronary arteriography, left ventriculography, distal aortic root
shot.
A. DYE USED: Less than 100 cc's of dye.
B. COMPLICATIONS: No acute or apparent complications.
C. PREMEDICATIONS: 25mg of p.o. Benadryl and 5mg of p.o.
Valium.
D. TECHNIQUE: Modified Seldinger technique through the right
femoral artery and right femoral vein.
E. CATHETERS: 5 French sheath in right femoral artery, 7
French sheath in the right femoral vein with 7 French Swan-
Ganz catheter. JL4 and JR4 were noted and 5 French pigtail
were used.
PRESSURES/SATURATIONS: IVC saturation was 78. SVG 65, PA 70, high
RA 71.8, RV 69.5. AO 99%. No apparent shunting was identified on
the right side.
Cardiac output and index using thermodilution were 4.5 and 2.6.
Pressures were noted. Aortic pressure was 130/80. LV was
129/17. EDP was normal. No apparent aortic valve gradient was
noted. RA mean pressure was 4. RV was 20/4. PA pressure was
about 20/10. Right sided pressures were relatively within normal
limits.
ANGIOGRAMS:
A. LEFT MAIN: Left main coronary artery had a normal
arteriogram.
B. LEFT ANTERIOR DESCENDING: The LAD had a 20-30%
irregularities throughout its course. Some calicification.
First diagonal was a moderate calibered vessel and had a normal arteriogram.
C. CIRCUMFLEX: The circumflex artery was a moderate calibered
vessel artery. It gave rise to an OM1, which was moderate
and had 20-30% irregularities. OM2 was moderate and had 20-
30% irregularities.
D. RAMUS INTERMEDIUS BRANCH: Ramus intermedius branch was a
moderate calibered vessel artery. It had 20-30%
irregularities.
E. RIGHT CORONARY ARTERY: RCA was dominant. It had 20%
irregularities. PDA was a moderate calibered vessel artery
and had a normal arteriogram. PL branch was a moderate
calibered vessel artery and had a normal arteriogram.
LEFT VENTRICULAR: LV was visualized in RAO projection. EF was
estimated at 60%. Plus 1 MR was noted. Volumes were within
normal limits.
DISTAL AORTIC ROOT SHOT: Distal aortic root looked at the renal
arteries non-selectively, which did not have any significant
disease. 20-30% irregularities were noted in the left renal
artery.
IMPRESSION:
1. Right-sided pressures were normal. No apparent shunting
was noted on the right side. Cardiac output index was
normal. LVEF was normal. Plus 1 MR is noted. Coronaries
had 20-30% irregularities in the left system and right
system.
2. Renals did not have any significant disease