LHC w/aortogram and peripheral angiography

Can someone help me code the Aortogram. It is separately billable from the LHC,correct?

93458.26 and

75630.26(59), or 93567?

PROCEDURES PERFORMED:

1. Left heart catheterization.

2. Coronary angiography.

3. Left ventriculogram.

4. Left internal mammary artery angiography.

5. Aortogram and peripheral runoff angiography.

INDICATION: The patient is a man who has significant peripheral

arterial disease with a history of previous bilateral iliac stents and left

femoral artery stent who has severe diffuse left lower extremity. He was

preop for vascular surgery, but a stress test preoperatively was abnormal.

He was referred for diagnostic angiogram to rule out obstructive coronary

disease.

DESCRIPTION OF PROCEDURE: After informed consent was obtained, he was

brought to the cardiac cath lab, where he was prepped and draped in sterile

fashion. Lidocaine 2% was used to anesthetize the right radial artery

region. Please note, Allen's test was normal prior to procedure. A Terumo

Glidesheath, PA was advanced after which a peak catheter was advanced

through the aortic root and engaged in the left coronary artery. After

that, angiography of the right coronary artery was performed. After that,

the catheter was withdrawn to the aortic arch and angiography of the left

subclavian artery and left internal mammary artery was performed. Catheter

was exchanged for 6-French pigtail catheter, which was then advanced to the

left ventricle. Single planer left ventriculogram was performed. Catheter

was then removed. A TR band was then applied. The patient was sent to the

cardiac support unit for admission due to evidence of severe ostial left

main disease and total occlusion of the right coronary artery, and the

patient is awaiting for bypass.

RESULTS: Hemodynamics: Left ventricular pressure 145/4, end-diastolic

pressure of 18.

Coronary angiography:

1. Left main coronary artery: A 2 mm vessel that has an ostial stenosis

of 60% to 70% stenosis. It bifurcates in the usual manner without

anomaly.

2. Left anterior descending artery: A small caliber 1.5 mm vessel with

mild diffuse disease. No significant obstruction.

3. Left circumflex artery: A 2 mm vessel. In some views at the mid

portion, there is a 70% to 80% stenosis. The first obtuse marginal

artery is a 2 mm vessel that is normal. There is evidence of grade 2

left-to-right collateralization.

4. Right coronary artery: A diminutive right coronary artery with chronic

total occlusion of a long segment of its midportion. The distal

portion gives rise to a small caliber PDA, which may be small in

caliber, due to chronic total occlusion. There is evidence of

collateral flow from the left.

5. Left internal mammary artery: This is an anastomosed vessel, 2 mm and

is normal, and suitable for use in bypass grafting.

6. Left ventriculogram: Normal left ventricular size and systolic

function. Ejection fraction of 65%. No mitral regurgitation. No

transaortic valve pressure gradient. Aortogram was also performed that

showed bilateral iliac stent that is patent and left femoral artery

stent that is occluded.

SUMMARY:

1. High-grade ostial left main stenosis with chronic total occlusion of

the right coronary artery, receiving left-to-right collateralization.

2. Adequate bypass graft target.

3. Left internal mammary artery suitable for use in bypass grafting.

4. Normal left ventricular systolic function.

5. No mitral regurgitation.

6. No aortic stenosis.

7. Peripheral arterial disease.

thanks!

LHC w/aortogram and peripheral angiography