Heart and Right Femoral Artery

22. Provide the CPT code(s) for the following scenario, left heart catheterization with coronary angiography and left ventriculogram.

PROCEDURE: The right groin was prepped and draped in the usual fashion. Seldinger technique was used, and a 6-French sheath was placed in the right femoral artery. A local anesthetic was used and sublingual nitroglycerin was given; no heparin was used. The left and right coronary arteries were selectively opacified in the LAO and RAO projections using manual injections of Optiray. A ventriculogram was done in the RAO projection with the use of a 6-French pigtail catheter. The catheters were then withdrawn, the sheath was removed and VasoSeal applied, and the patient was sent to her room in good condition without complications. PRESSURES: Aorta 117/63, LV 110/2-6

RIGHT CORONARY ARTERY: This is a dominant vessel. There is a long segment of severe subtotal disease extending from the proximal portion to almost the mid third. The rest of this vessel also appears to be diffusely diseased. The posterior descending branch is identified and this is 80% narrowed at its ostium. There is another 90% lesion in the distal 1/3 of this vessel. The AV branch is diminutive. LEFT CORONARY ARTERY: Left main trunk is calcified and has a 60%–70% distal narrowing. Left anterior descending is severely diseased from its origin, and gives off a diagonal and septal perforator and then the LAD is totally occluded. The circumflex calcification is seen in the main trunk where moderate plaque is seen compromising the lumen about 50%–60%. The circumflex then divides into two branches; the first is the lateral branch and then a second lateral branch. The first lateral branch is severely narrowed in its proximal portion to 90%, and then has another long segment of about 75% narrowing. This does appear to be a diffusely diseased vessel. The second lateral branch also has a long segment of 90% disease distally. The terminal AV branch of the circumflex is completely occluded. LEFT VENTRICLE: End systolic and end diastolic volumes are increased. There is diffuse impairment of contractility indicating diffuse multiwall ischemia. Overall contractility is mild-to-moderately impaired with an ejection fraction of the post PVC beat being around 40% or so. No major wall segment abnormalities are noted. The mitral and aortic valves are normal. The descending aorta is slightly dilated.