Need Verification Help Please with Codes

Hey all, just need help verifying I am going/thinking in the right direction. I am going to post the report and put my thoughts at the end!! As usual, Thanks in Advance for All Help!!

Procedures Performed:

1. 6-french sheath placement in the right common femoral artery with a great amount of difficulty, but no complications

2. coronary angiography

3. left heart catheterization

4. left ventriculogram

5. right commom femoral artery angiography

6. thoracic aortogram

7. abdominal aortogram x 2

description of procedure:

details explained to patient in great detail; transferred to coronary suite, prepped and draped. underwent 6 French sheath placed in right common femoral artery with a great amount of difficulty, but no complication. coronary angiography was then performed.

as we are attempting to go up, we were able to eventually obtain access after stick x 3. we used the right coronary artery. we continued to get stuck in the distal aorta. there was a shot of the right common femoral artery showing a small vessel and the stick is actually at the profunda femoral artery. then we proceeded with the diagnostic right coronary artery catheter.

we eventually were able to get up into the aortic root. the diagnostic right was unable to selectively engage the RCA and a multipurpose was used. Final injection showed that the RCA was large, heavily stented proximal to mid, 40% to 50% in-stent restenosis, worse at the mid stent area. Posterior descending artery was large without significant occlusions and collaterals were seen to a small left circumflex branch.

catheter exchange is made over a long wire with the left sided diagnostic catheter. coronary angiography was then performed.

1. left main is large, calcified, no stent occlusion seen.

2. left circumflex large, nondominant, proximal stent widely patent. 10% in-stent restenosis. tapers to a small vessel.

3. left anterior descending artery is large, calcified 30% proximal and 30% mid. diagonal artery #1 is large with 50% proximal stenosis seen.

a long J-wire is used for catheter exchange again and we exchanged out to a 4-french pigtail. left ventriculogram was performed. LVEF greater than 55%. trace mitral regurgitation, no aortic stenosis, the dye is seen through follow-through the thoracic aorta. thoracic aneurysm detected.

the 4-french pigtail catheter was moved farther up into the ascending aorta for selective angiography. Thoracic aortogram demonstrates a large thoracic aneurysm of the ascending aorta.

next the diagnostic 4 French pigtail was moved distally to show the abdominal aorta which injection is performed x 2. the abdominal aorta is heavily calcified. there is 40% stenosis above the renal artery, 70% at the renal artery and 80% below the renal arteries with heavy calcifications noted to the abdominal aorta, dye is also seen in follow through here and we were able to see the right common iliac artery which showed a 60% to 70% ostial lesion noted.

at the close of the case, patient underwent manual removal of our introducer sheath with good hemostasis. no hematoma. about 235 cc of contrast had been used here due to difficult catheterization and multiple aortic views needed to take. consult vascular surgery, require overnight stay.

Ok, I talked with the Cath lab,because at first I thought maybe the thoracic aortogram was from dye follow through. Cath lab said a thoracic aortogram was done along with the abdominal (he looked at the films for me due to all the questions I had).

I've not coded one quite like this yet-do you get both of these? Since I have LHC, do you get credit for moving the catheter?

I am so confused! Thanks for help.

Beverly Abernathy, CPC, CIMC

Need Verification Help Please with Codes