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left heart cath w/o ventriculography sel native cor angiog sel vein graft angiog

Monica Posted Tue 30th of October, 2012 01:58:58 AM

CPT, dx and modifier's please:

Post-op dx: 1.
severe three-vessel coronary artery disease.
Occlusion of the native right coronary artery.
Occlusion of the saphenous vein graft to the right coronary artery.
Occluation of the first obtuse marginal branch of the circumflex
Occlusion of the med left anterior descending.
Patent Y-graft to the left coronary arter with one limb to the left anterior descending and the other limb to the diagonal branch. This vein graft is widely patent.

Procedure:
Using standard technique, a #6-French sheath was inserted in the right femoral artery. The above-named procedures were performed without complications. We did cross the aortic valve with the right Judkins catheter for measurement of pressure and a pull-back pressure measurement. Left ventriculography was not performed secondary to elevated creatinine.

Findings:
Hemodynamics :left ventricle 130/15. Aorta 130/80
Left ventriculography: This was not performed
Coronary angiography
A. Left main: no high-grade stenosis was identified.
B. Circumflex: The circumflex in the large first obtuse marginal appears to be occluded. The circumflex in the arteriovenous groove is patent.
C. Left anterior descending: There is significant proximal left anterior descending followed by left anterior descending disease followed by occlusion of the left anterior descending after the large septal branches. The distal left anterior descending fills nicely via graft flow.
4. Vein graft angiography:
A. Left coronar arter: One vein graft to the left coronary arter is identified that is completely occluded proximally. A separate ostium at the aort is the Y-graft. it is widely patent. one limb goes to the left anterior descending with complete filling of the left anterior descending. There is really almost no perceptible disease in the veing graft itself or in the continuation of the distal left anterior descending. The second limb of this graft goes to a diagonal branch. There is good filling of the diagonal. The graft itself looks pristine.
B. Right coronary veing graft: The right coronary vein graft is occluded proximally. The native right coronary artery is occluded.

Conclusions:
1. Severe native three-vessel coronary arter disease with essential occlusion of all the native coronary arteries.
2. Occlusion of the saphenous vein graft to the right coronary artery.
3. Patent saphenous vein graft to the left coronary artery. This is a Y-graft. One limb goes to the left anterior descending and the other limb goes to the principal diagonal branch . The graft itself looks outstanding with excellent filling of the distal territory of the left anterior descending and diagonal.
4. Occlusion of the circumflex obtuse marginal. This has not been bypassed. No collateral filling of the circumflex was identified.

SuperCoder Answered Tue 30th of October, 2012 21:15:49 PM

Please contact customer service

Monica Posted Fri 02nd of November, 2012 02:30:49 AM

Would you like to explain to me WHY you are even here to begin with when you cannot provide the answers to the questions we have PAID FOR?? You are NOT providing the services I have paid for whatsoever and your service is incredibly POOR

Monica Posted Fri 02nd of November, 2012 02:31:55 AM

Not only that, but you have provided INCORRECT answers to the questions I have submitted on at least 2, per our auditors.

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