Can somebody help me with procedure coding of below report? Any additional helping material to crack this will also be appreciated
PREOPERATIVE DIAGNOSIS: Severe symptomatic aortic stenosis (non-rheumatic).
POSTOPERATIVE DIAGNOSIS: Severe symptomatic aortic stenosis (non-rheumatic).
PROCEDURE:
1. Intraoperative transthoracic echocardiography.
2. Transcatheter aortic valve replacement via right common femoral artery utilizing percutaneous approach with a 26 mm Edwards SAPIEN 3 valve.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and laid in supine position on the operating table. Intravenous sedation was administered by the anesthesia service. A transthoracic echo probe was placed and it revealed well-preserved left ventricular function with severe valvular aortic stenosis. Intravenous antibiotics were administered. The patient was prepped and draped in standard sterile fashion. 1% lidocaine was used to infiltrate the skin and subcutaneous tissue in both groins. Percutaneous access of the left common femoral artery and left common femoral vein were obtained. Utilizing modified Seldinger technique, a 6-French sheath was placed in the left common femoral artery and a 7-French sheath placed in the left common femoral vein. The right common femoral artery was then accessed utilizing a micropuncture technique. After angiographic confirmation of access into the right common femoral artery, two Perclose devices were used to secure the right common femoral arterial puncture site for closure later. A 10-French dilator was then inserted. A 0.035 Amplatz Super Stiff wire was then advanced to the 10-French dilator. The tract was then dilated to 14 French and a 14-French sheath was placed without difficulty. A temporary pacemaker wire was advanced through the left common femoral vein and positioned in the right ventricular apex with good thresholds. An angled pigtail catheter with 0.035 J-wire was advanced through the left common femoral artery and positioned in the aortic root in the right coronary cusp. Multiple projections and root injections were used to obtain a coplanar view of the valve. Once we were satisfied with our implanting view, the patient was then heparinized. An AL-1 catheter was then advanced over top of the Amplatz Super Stiff wire and positioned in the ascending aorta. The Super Stiff wire was withdrawn and a 0.035 straight wire was then used to cross the aortic valve. The AL-1 catheter was then advanced across the aortic valve. The straight wire was removed and exchanged for an Amplatz extra stiff wire, which had been precurved. The AL-1 catheter was removed. A 26 mm SAPIEN 3 valve mounted on the Commander delivery system was then advanced over top of the Amplatz extra stiff wire. It was appropriately aligned under fluoroscopy on the balloon. The device was then advanced across the aortic valve and, under rapid ventricular pacing, the valve was deployed without difficulty. The deployment device was withdrawn. Initial echocardiographic pictures revealed adequate positioning with no perivalvular leak. We were happy with our result. We then withdrew the deployment device and the guidewire from the ventricle. The 14-French sheath was then removed and the Perclose devices were secured. Protamine had been administered. A 6-French Angio-Seal was used to secure the left common femoral arterial site. Manual pressure was used for hemostasis in the left venous site. Sterile dressings were applied. The patient was subsequently transferred to the cath lab holding area in stable condition. All sponge and instrument counts were correct per nursing service in attendance.
PREOPERATIVE DIAGNOSIS: Severe symptomatic aortic stenosis (non-rheumatic).
POSTOPERATIVE DIAGNOSIS: Severe symptomatic aortic stenosis (non-rheumatic).
PROCEDURE:
1. Intraoperative transthoracic echocardiography.
2. Transcatheter aortic valve replacement via right common femoral artery utilizing percutaneous approach with a 26 mm Edwards SAPIEN 3 valve.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and laid in supine position on the operating table. Intravenous sedation was administered by the anesthesia service. A transthoracic echo probe was placed and it revealed well-preserved left ventricular function with severe valvular aortic stenosis. Intravenous antibiotics were administered. The patient was prepped and draped in standard sterile fashion. 1% lidocaine was used to infiltrate the skin and subcutaneous tissue in both groins. Percutaneous access of the left common femoral artery and left common femoral vein were obtained. Utilizing modified Seldinger technique, a 6-French sheath was placed in the left common femoral artery and a 7-French sheath placed in the left common femoral vein. The right common femoral artery was then accessed utilizing a micropuncture technique. After angiographic confirmation of access into the right common femoral artery, two Perclose devices were used to secure the right common femoral arterial puncture site for closure later. A 10-French dilator was then inserted. A 0.035 Amplatz Super Stiff wire was then advanced to the 10-French dilator. The tract was then dilated to 14 French and a 14-French sheath was placed without difficulty. A temporary pacemaker wire was advanced through the left common femoral vein and positioned in the right ventricular apex with good thresholds. An angled pigtail catheter with 0.035 J-wire was advanced through the left common femoral artery and positioned in the aortic root in the right coronary cusp. Multiple projections and root injections were used to obtain a coplanar view of the valve. Once we were satisfied with our implanting view, the patient was then heparinized. An AL-1 catheter was then advanced over top of the Amplatz Super Stiff wire and positioned in the ascending aorta. The Super Stiff wire was withdrawn and a 0.035 straight wire was then used to cross the aortic valve. The AL-1 catheter was then advanced across the aortic valve. The straight wire was removed and exchanged for an Amplatz extra stiff wire, which had been precurved. The AL-1 catheter was removed. A 26 mm SAPIEN 3 valve mounted on the Commander delivery system was then advanced over top of the Amplatz extra stiff wire. It was appropriately aligned under fluoroscopy on the balloon. The device was then advanced across the aortic valve and, under rapid ventricular pacing, the valve was deployed without difficulty. The deployment device was withdrawn. Initial echocardiographic pictures revealed adequate positioning with no perivalvular leak. We were happy with our result. We then withdrew the deployment device and the guidewire from the ventricle. The 14-French sheath was then removed and the Perclose devices were secured. Protamine had been administered. A 6-French Angio-Seal was used to secure the left common femoral arterial site. Manual pressure was used for hemostasis in the left venous site. Sterile dressings were applied. The patient was subsequently transferred to the cath lab holding area in stable condition. All sponge and instrument counts were correct per nursing service in attendance.
