should i code 92920?

bhargavi

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Conclusion



This patient with prior treatment for hypertension, dyslipidemia, morbid obesity presented with substernal chest discomfort at rest.  Patient was having persistent angina for 3 days.  She presented to the Sussex campus and was found to have elevated troponins which peaked at 0.55.  Left heart catheterization was recommended.

After obtaining informed consent, the patient was prepped and draped in sterile fashion.  A 6 French glide sheath was inserted in the right radial artery.  Radial cocktail consisting of 200 mcg of Cardene and 200 mcg of nitroglycerin was administered via right radial artery sheath to prevent radial artery spasm.  A 5 French Judkins left and right coronary catheters was used for left and right coronary angiography.  TR band was placed on right radial artery access site for patent hemostasis.

I attest that moderate conscious sedation was provided under my direct supervision with the sedation trained nurse using 1 mg of intravenous Versed and 50 mcg of fentanyl to sedate the patient.  Start time 12:53 PM and end time was 13:39 PM.  There were no complications.  See nurse's sedation sheet, for complete pre-and post service details.

Hemodynamics:

The aortic pressure was 145/78 mmHg.

Coronary Angiography:

Right coronary artery large caliber dominant vessel which appears to be patent throughout its proximal and midportion.  There is a focal distal 90% ulcerated plaque.  RPDA and RPL are small to medium caliber vessels with luminal irregularities.

Left Main coronary artery is patent.

Left anterior descending is a large-caliber vessel with luminal irregularities.  Diagonal 1 is a large caliber vessel with luminal irregularities.  Diagonal 2 is a medium caliber vessel with luminal irregularities.

Left circumflex is a large caliber nondominant vessel with luminal irregularities.  Tooze marginal 1 is a large-caliber vessel with luminal irregularities.  Obtuse marginal 2 is a medium caliber vessel with luminal irregularities.

The patient was then transferred to the recovery area in stable condition:

Summary conclusion:

1.  Severe one-vessel CAD.
2.  Elevated troponins
3.  Hypertension
4.  Dyslipidemia
5.  Morbid obesity

Recommendation:

Recommend PCI of distal RCA.

6 French JR4 guide was used to engage right coronary artery.  Patient was anticoagulated using 80 units/kg heparin.  Run-through wire was advanced into distal RCA.  Diagnostic angiogram after passing the wire through the lesion revealed TIMI-3 flow into the distal vessel without evidence of any distal vessel stenosis.  Angiogram was performed in multiple views to confirm this new finding.  Procedure was aborted at this time.  Guidewire was removed.  There was no evidence of dissection or perforation.

thanks in advance

should I code 93454, 92920-rc or I cannot code 92920






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Contrast Administered (mL): 180​

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Printable Result Report​

Encounter​



 
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