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this one I am confuse when it comes to left anterior descending coronary artery and left circumflex. now my question do I code each one of these as a...
this one I am confuse when it comes to left anterior descending coronary artery and left circumflex. now my question do I code each one of these as a procedure?
do I also code the dx in the conclusion. just need some direction. thank you
PROCEDURES PERFORMED: Left-sided heart catheterization, selective coronary arteriography, left ventriculography
INDICATION: Ongoing unstable angina with acute inferior-wall MI, initial episode. See the prior (Case 3-2) records for further details.
PROCEDURE NOTE: Please refer to the procedure note in the enclosed cardiac catheterization log sheet. This procedure is done through the modified Seldinger technique via the right femoral approach without any complications. At the end of the case, the right femoral arterial sheath was left in place and the decision was made to intervene with angioplasty and stenting. See the upcoming angioplasty and stenting reports for details. The patient suffered no complications from the angiogram.
RESULTS: Results are as follows.
I. HEMODYNAMICS: Hemodynamics are listed fully on separate sheets within this report. Please refer to those separate sheets for details.
II. FLUOROSCOPY: Fluoroscopy reveals no valvular calcifications. No coronary artery calcifications are noted.
III. ANGIOGRAPHY:
A. LEFT MAIN CORONARY ARTERY: The left main coronary artery is normal.
B. LEFT ANTERIOR DESCENDING CORONARY ARTERY: The anterior descending coronary artery at its midportion has a 75% focal stenosis followed by a 50% focal stenosis in its midportion. The remainder of the LAD system is normal.
C. LEFT CIRCUMFLEX ARTERY: The left circumflex artery is an anatomically dominant vessel. The left circumflex artery is stump-occluded at its midportion. Just before this midportion stump occlusion, the left circumflex artery gives rise to its major marginal branch. This major marginal branch has a 95% focal stenosis proximally. The rest of the left circumflex system appears normal.
D. RIGHT CORONARY ARTERY: The right coronary artery is an anatomically nondominant, small 2-mm-caliber vessel. The right coronary artery is diffusely diseased at its proximal through early midsection over about a 20-mm length with up to 95% luminal compromise. The rest of this RCA system is normal.
IV. VENTRICULOGRAPHY:
A. QUALITATIVE: The left ventricle displays normal contractility except there is slight localized inferior hypokinesis near the apex. No mitral valve prolapse or mitral regurgitation is seen on normal sinus rhythm beats.
B. QUANTITATIVE: The calculated left ventricular ejection fraction is 65%.
Note that the coronary artery lesions described above are atherosclerotic in nature.
CONCLUSION:
1. Severe three-vessel atherosclerotic heart disease with the culprit for his STEMI-MI being a stump-occluded dominant circumflex.
2. Well-preserved left ventricular function with only slight inferior-wall localized hypokinesis.
3. Angiographically normal cardiac output.
4. See report above for details.
RECOMMENDATIONS: Angioplasty and stenting of the patient's culprit for the MI being his stump-occluded circumflex. While we are at this procedure, if this goes smoothly, I will go ahead and angioplasty and consider stenting his circumflex marginal and also angioplasty his RCA system and LAD system.
