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Cath + Angio

  1. #1
    Question Cath + Angio
    Exam Training Packages
    Is it appropriate to code this as 93458-26, 75710-26-59?

    PROCEDURES PERFORMED:

    -- Left heart catheterization with ventriculography.
    -- Left coronary angiography.
    -- Right coronary angiography.
    -- Aorta Iliac Unilateral.
    -- Right leg angiography.

    RECOMMENDATIONS:
    Only RLE imaging was performed in the cath lab.

    Severe disease involving the RLE was visualized only to the level of TP
    trunk.

    A full LE run-off and Atherectomy of the LE shall be scheduled in two
    weeks.

    No dye reaction occurred (pt was premedicated).

    INDICATIONS: Angina/MI: atypical chest pain.

    PRIOR DIAGNOSTIC TEST RESULTS: Nuclear pharmacologic stress test was
    positive.

    VENTRICLES: There were no left ventricular global or regional wall motion
    abnormalities. EF calculated by contrast ventriculography was 60 %.

    VALVES: AORTIC VALVE: The aortic valve was evaluated by left
    ventriculography. The aortic valve appeared to be structurally normal. The
    aortic valve leaflets exhibited normal thickness and normal excursion.
    There was no aortic stenosis. MITRAL VALVE: The mitral valve was evaluated
    by left ventriculography. The mitral valve appeared grossly normal. The
    mitral leaflets exhibited normal thickness and normal excursion. The
    mitral valve exhibited no regurgitation.

    CORONARY VESSELS: The coronary circulation is right dominant. Coronary
    angiography demonstrated minor luminal irregularities. Left main:
    Angiography showed minor luminal irregularities. LAD: Angiography showed
    minor luminal irregularities. Mid LAD: There was a 30 % stenosis.
    Circumflex: Angiography showed minor luminal irregularities. RCA:
    Angiography showed minor luminal irregularities.

    RIGHT LOWER EXTREMITY VESSELS: Right lower extremity angiography reveals
    severe atherosclerosis. Proximal right deep femoral: There was a 70 %
    stenosis. Mid right deep femoral: There was a 80 % stenosis. Distal right
    deep femoral: There was a 80 % stenosis. Proximal right anterior tibial:
    There was a 100 % stenosis. Right posterior tibial: There was a 100 %
    stenosis.

    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.

    -- 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. Ventriculography was performed using power injection of contrast
    agent. 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.

    -- Aorta Iliac Unilateral.

    -- Right leg angiography. A catheter was positioned.

    COMPLICATIONS:
    There were no adverse outcomes.
    PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
    Test started at 09:47. Test concluded at 10:05. RADIATION EXPOSURE:
    Fluoroscopy time: 2 min.
    HEMOSTASIS:
    The sheath was removed. The site was compressed manually. Hemostasis was
    successful.
    MEDICATIONS GIVEN:
    Midazolam, 1 mg, IV, at 09:44.
    CONTRAST GIVEN:
    Omnipaque 35 ml.

  2. #2
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by amym View Post
    Is it appropriate to code this as 93458-26, 75710-26-59?

    PROCEDURES PERFORMED:

    -- Left heart catheterization with ventriculography.
    -- Left coronary angiography.
    -- Right coronary angiography.
    -- Aorta Iliac Unilateral.
    -- Right leg angiography.

    RECOMMENDATIONS:
    Only RLE imaging was performed in the cath lab.

    Severe disease involving the RLE was visualized only to the level of TP
    trunk.

    A full LE run-off and Atherectomy of the LE shall be scheduled in two
    weeks.

    No dye reaction occurred (pt was premedicated).

    INDICATIONS: Angina/MI: atypical chest pain.

    PRIOR DIAGNOSTIC TEST RESULTS: Nuclear pharmacologic stress test was
    positive.

    VENTRICLES: There were no left ventricular global or regional wall motion
    abnormalities. EF calculated by contrast ventriculography was 60 %.

    VALVES: AORTIC VALVE: The aortic valve was evaluated by left
    ventriculography. The aortic valve appeared to be structurally normal. The
    aortic valve leaflets exhibited normal thickness and normal excursion.
    There was no aortic stenosis. MITRAL VALVE: The mitral valve was evaluated
    by left ventriculography. The mitral valve appeared grossly normal. The
    mitral leaflets exhibited normal thickness and normal excursion. The
    mitral valve exhibited no regurgitation.

    CORONARY VESSELS: The coronary circulation is right dominant. Coronary
    angiography demonstrated minor luminal irregularities. Left main:
    Angiography showed minor luminal irregularities. LAD: Angiography showed
    minor luminal irregularities. Mid LAD: There was a 30 % stenosis.
    Circumflex: Angiography showed minor luminal irregularities. RCA:
    Angiography showed minor luminal irregularities.

    RIGHT LOWER EXTREMITY VESSELS: Right lower extremity angiography reveals
    severe atherosclerosis. Proximal right deep femoral: There was a 70 %
    stenosis. Mid right deep femoral: There was a 80 % stenosis. Distal right
    deep femoral: There was a 80 % stenosis. Proximal right anterior tibial:
    There was a 100 % stenosis. Right posterior tibial: There was a 100 %
    stenosis.

    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.

    -- 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. Ventriculography was performed using power injection of contrast
    agent. 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.

    -- Aorta Iliac Unilateral.

    -- Right leg angiography. A catheter was positioned.

    COMPLICATIONS:
    There were no adverse outcomes.
    PROCEDURE COMPLETION: The patient tolerated the procedure well. TIMING:
    Test started at 09:47. Test concluded at 10:05. RADIATION EXPOSURE:
    Fluoroscopy time: 2 min.
    HEMOSTASIS:
    The sheath was removed. The site was compressed manually. Hemostasis was
    successful.
    MEDICATIONS GIVEN:
    Midazolam, 1 mg, IV, at 09:44.
    CONTRAST GIVEN:
    Omnipaque 35 ml.
    I agree with your code choices.

    HTH
    Danny L. Peoples
    CIRCC,CPC

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