CardioCoder79
Networker
I am thinking 36225, 37238, and 75605-26. CCI says that the 75605 is a component of 37238 but a modifier is allowed. Need help with this one please.
PROCEDURES PERFORMED:
1. Thoracic aortography with digital subtraction.
2. Selective left subclavian angiography.
3. PTA and stenting of the left subclavian with an Omnilink 8 x 29 mm
balloon expandable stent.
DESCRIPTION OF PROCEDURE: The patient was brought to the Cardiac
Catheterization Laboratory and was prepped and draped in the usual sterile
fashion. After informed consent was obtained and documented on the chart,
the patient was given conscious sedation of Versed and fentanyl.
Using the modified Seldinger technique, a 5-French sheath was placed in the
right femoral artery. A 5-French pigtail catheter was used for aortography.
A 5-French JL-4 catheter was used to selectively engage the left subclavian.
FINDINGS: The thoracic aorta is within normal limits of size. There is no
evidence of aneurysm. There is no evidence of aortic insufficiency. The
right brachiocephalic is widely patent. The right common carotid is widely
patent. The left common carotid is widely patent.
The left subclavian has a high-grade, 90% stenosis which appears to spare the
ostium. The left internal mammary artery is widely patent. The left
vertebral artery is widely patent with antegrade flow. There was a 65 mmHg
gradient across the stenosis.
INTERVENTION: A 7-French Cook guide sheath was introduced. The patient was
given systemic anticoagulation with unfractionated heparin.
A long Versacore wire was used to cross the lesion. Next, an Armada 7 x 20
mm balloon was used for lesion predilatation. After subsequent angiography,
an Omnilink 8 x 29 mm balloon expandable stent was deployed at nominal
pressure. Next, an Armada 8 x 20-mm balloon was used for postdilatation.
Final angiography revealed an excellent result with no residual stenosis.
The patient's preprocedural gradient was reduced to 0.
IMPRESSIONS:
1. High-grade left subclavian stenosis as outlined above.
2. Status post successful percutaneous transluminal coronary angioplasty
and stenting of the left subclavian with an Omnilink 8 x 29 mm bare-metal
balloon expandable stent.
PROCEDURES PERFORMED:
1. Thoracic aortography with digital subtraction.
2. Selective left subclavian angiography.
3. PTA and stenting of the left subclavian with an Omnilink 8 x 29 mm
balloon expandable stent.
DESCRIPTION OF PROCEDURE: The patient was brought to the Cardiac
Catheterization Laboratory and was prepped and draped in the usual sterile
fashion. After informed consent was obtained and documented on the chart,
the patient was given conscious sedation of Versed and fentanyl.
Using the modified Seldinger technique, a 5-French sheath was placed in the
right femoral artery. A 5-French pigtail catheter was used for aortography.
A 5-French JL-4 catheter was used to selectively engage the left subclavian.
FINDINGS: The thoracic aorta is within normal limits of size. There is no
evidence of aneurysm. There is no evidence of aortic insufficiency. The
right brachiocephalic is widely patent. The right common carotid is widely
patent. The left common carotid is widely patent.
The left subclavian has a high-grade, 90% stenosis which appears to spare the
ostium. The left internal mammary artery is widely patent. The left
vertebral artery is widely patent with antegrade flow. There was a 65 mmHg
gradient across the stenosis.
INTERVENTION: A 7-French Cook guide sheath was introduced. The patient was
given systemic anticoagulation with unfractionated heparin.
A long Versacore wire was used to cross the lesion. Next, an Armada 7 x 20
mm balloon was used for lesion predilatation. After subsequent angiography,
an Omnilink 8 x 29 mm balloon expandable stent was deployed at nominal
pressure. Next, an Armada 8 x 20-mm balloon was used for postdilatation.
Final angiography revealed an excellent result with no residual stenosis.
The patient's preprocedural gradient was reduced to 0.
IMPRESSIONS:
1. High-grade left subclavian stenosis as outlined above.
2. Status post successful percutaneous transluminal coronary angioplasty
and stenting of the left subclavian with an Omnilink 8 x 29 mm bare-metal
balloon expandable stent.