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The Next Step Advanced Medical Coding and Auditing 2017- 2018 1st Edition by Carol Buck
Edition 1ISBN: 978-0323430777The Next Step Advanced Medical Coding and Auditing 2017- 2018 1st Edition by Carol Buck
Edition 1ISBN: 978-0323430777 Exercise 2
Case 2-2
LOCATION: Inpatient, Hospital
PATIENT: Jo Littledove
REFERRING PHYSICIAN: James Noonar, MD
CARDIOLOGIST: Marvin Elhart, MD
INDICATIONS: Abnormal Cardiolite stress test and shortness of breath.
PROCEDURE: Right and left selective coronary angiogram, LV gram left heart, right femoral artery #6 French sheath, right femoral artery angiogram.
HEMODYNAMICS: Aortic pressure 138/57, LV 148/4. No aortic gradient on pullback.
RESULTS: Ventriculography: The LV displayed normal size with excellent contractility and no segmental wall motion abnormality. The ejection fraction is estimated at 60-80%.
Coronary Angiography
1. Right coronary artery: This is a dominant vessel. It has a shepherd's crook takeoff. Through its course the right coronary artery has no significant stenosis. Distally, it trifurcated to give rise to posterior descending artery, posterolateral branch, and a marginal branch. Through its course the right coronary artery has intimal disease from 10-20%.
2. Left main: Normal.
3. Circumflex artery: The circumflex artery is a codominant system. The circumflex in its midportion branched to give first marginal that is moderate in size, tortuous, but no significant obstructive disease, and a very large second marginal that has in its midportion 40% stenosis. Distally, it branched to give smaller marginals.
4. Left anterior descending artery: After the takeoff of the left main, has steep angulations of close to 90 degrees. Thereafter it takes off and through its course has significant tortuosity. The proximal part of the left anterior descending appears slightly hazy, probably from the angulations; the artery itself has 30% stenosis. At the level of the stenosis there are two diagonals taking off, the first of which is before the stenosis and is small, and the second one is moderate in size and has at its origin an ostial stenosis that appeared to be 60%. The left anterior descending artery is tortuous and in its midportion gave rise to another diagonal that appeared to be free of any significant disease.
IMPRESSION/CONCLUSION: Normal left ventricular systolic functions with disease involving predominantly the left anterior descending artery that appeared to be in its proximal third of 40-50% at the level of the second diagonal. Angiographically, it did not appear severely obstructed, with some mild disease involving the right coronary artery at the circumflex. At this point, my recommendation is to aggressively manage her medically, and if we are unable to control her symptoms with medications, then later on we might consider percutaneous revascularization of the left anterior descending artery. Considering her size, the location of the lesion, and the takeoff of the left anterior descending artery, this procedure is not without risk.
CPT Code(s): _________________
ICD-10-CM Code(s): _________________
Abstracting Questions:
1. What does the LV referred to in the report stand for? _________________
2. What is the definition of "circumflex"? _________________
3. The report states in point 4 that the left anterior descending artery has significant tortuosity. What does this mean? _________________
LOCATION: Inpatient, Hospital
PATIENT: Jo Littledove
REFERRING PHYSICIAN: James Noonar, MD
CARDIOLOGIST: Marvin Elhart, MD
INDICATIONS: Abnormal Cardiolite stress test and shortness of breath.
PROCEDURE: Right and left selective coronary angiogram, LV gram left heart, right femoral artery #6 French sheath, right femoral artery angiogram.
HEMODYNAMICS: Aortic pressure 138/57, LV 148/4. No aortic gradient on pullback.
RESULTS: Ventriculography: The LV displayed normal size with excellent contractility and no segmental wall motion abnormality. The ejection fraction is estimated at 60-80%.
Coronary Angiography
1. Right coronary artery: This is a dominant vessel. It has a shepherd's crook takeoff. Through its course the right coronary artery has no significant stenosis. Distally, it trifurcated to give rise to posterior descending artery, posterolateral branch, and a marginal branch. Through its course the right coronary artery has intimal disease from 10-20%.
2. Left main: Normal.
3. Circumflex artery: The circumflex artery is a codominant system. The circumflex in its midportion branched to give first marginal that is moderate in size, tortuous, but no significant obstructive disease, and a very large second marginal that has in its midportion 40% stenosis. Distally, it branched to give smaller marginals.
4. Left anterior descending artery: After the takeoff of the left main, has steep angulations of close to 90 degrees. Thereafter it takes off and through its course has significant tortuosity. The proximal part of the left anterior descending appears slightly hazy, probably from the angulations; the artery itself has 30% stenosis. At the level of the stenosis there are two diagonals taking off, the first of which is before the stenosis and is small, and the second one is moderate in size and has at its origin an ostial stenosis that appeared to be 60%. The left anterior descending artery is tortuous and in its midportion gave rise to another diagonal that appeared to be free of any significant disease.
IMPRESSION/CONCLUSION: Normal left ventricular systolic functions with disease involving predominantly the left anterior descending artery that appeared to be in its proximal third of 40-50% at the level of the second diagonal. Angiographically, it did not appear severely obstructed, with some mild disease involving the right coronary artery at the circumflex. At this point, my recommendation is to aggressively manage her medically, and if we are unable to control her symptoms with medications, then later on we might consider percutaneous revascularization of the left anterior descending artery. Considering her size, the location of the lesion, and the takeoff of the left anterior descending artery, this procedure is not without risk.
CPT Code(s): _________________
ICD-10-CM Code(s): _________________
Abstracting Questions:
1. What does the LV referred to in the report stand for? _________________
2. What is the definition of "circumflex"? _________________
3. The report states in point 4 that the left anterior descending artery has significant tortuosity. What does this mean? _________________
Explanation
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Verified
The Next Step Advanced Medical Coding and Auditing 2017- 2018 1st Edition by Carol Buck
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