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 was 8:47 AM and end time was 9:58 AM. There were no complications. See nurse’s sedation sheet, for complete pre-and post service details.
Hemodynamics:
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The aortic pressure was 100/57 mmHg.
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Coronary Angiography:
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Right coronary artery is medium caliber dominant vessel with severe diffuse disease and 100% mid vessel CTO. Distal vessels filling via collaterals from left to right and right to right.
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Left Main coronary arteries pain with mild diffuse disease.
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Left anterior descending is a medium caliber vessel with ostial 99% calcified lesion. Mid mild diffuse disease. Distal focal 60-70% disease.
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Left circumflex is a medium caliber vessel with mild proximal disease. AV groove circumflex is a small size vessel with severe diffuse disease. Obtuse marginal 1 is a large caliber vessel with tubular 70-80% disease.
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The patient was then transferred to the recovery area in stable condition:
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Summary conclusion:
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1. severe multivessel coronary disease.
2. Ischemic cardiomyopathy
3. Exertional angina
4. Hypertension
5. Dyslipidemia
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Recommendation:
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Planned PCI of left circumflex in the setting of ischemic heart myopathy and exertional angina.
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6 French EBU 3.75 guide was used to engage left coronary system. run through wire was advanced into distal left circumflex. Lesion was predilated using a 2.5 x 15 mm semi-compliant balloon. Resolute integrity 2.5 x 22 mm stent was deployed into left circumflex/OM1. Stent was postdilated using a 2.75 x 8 mm noncompliant balloon. Post procedure there was TIMI-3 flow noted in distal vessel without evidence of perforation or dissection.
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6 French AL 0.75 guide was used to engage right coronary system. Fielder FC wire was advanced through a 1.5 mm over-the-wire balloon into the proximal RCA. Wire escalation technique was used to cross the CTO which was unsuccessful due to lack of guide support and equipment. Procedure was aborted and postprocedure angiography did not reveal evidence of perforation or dissection. Patient remained hemodynamically stable throughout the procedure.
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thanks in advance
I am thinking c9600-lc but can I also bill for cto vessel 92943-74? I bill for hospital.