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Textbook question from ICD-10-PCS An Applied Approach 2019 Edition Please answer these questions in ICD-10-PCS terms. If you have the time can you please elaborate on each of the question. Section? Body System? Root Operation? Body Part? Approach? Device: Qualifier? How many code(s) are needed to dissect this operative report? Final code(s)


residual stenosis. There was some size discrepancy between the proximal
and mid RCA. A 3.0 x 28 mm bare-metal stent, Vision, was deployed at the
lesion site and inflated to nominal pressures. TIMI 3 flow was finally obtained.
In the mid to distal RCA, there was an eccentric 80 percent stenosis, so the
2.5 x 12 balloon was carefully taken past the proximal stent and positioned.
This more distal lesion inflated at nominal pressures. The balloon was then
removed and a 3.0 x 12 mm bare-metal stent, Vision, was positioned in the
distal RCA and dilated at nominal atmospheres. This stent balloon was then
removed. Next, a noncompliant 3.25 x 12 balloon was positioned within the
stent margins and was inflated at pressures for a reference diameter 3.30
mm. This balloon was then removed. Next, a 3.25 x 20 noncompliant balloon
was positioned within the proximal stent margins and inflated to the rated
stent diameter in overlapping fashion. It should be noted the patient was on
aspirin, Plavix, and Angiomax for the procedure as well as received
nitroglycerin intracoronary at various times throughout the procedure. Pigtail
catheter was used to perform left heart catheterization and the LV pressures
measured and pullback across the aortic valve recorded. There were
acceptable results, so the equipment was removed from the right coronary
and sheath upsized to balloon pump sheath. Balloon pump was positioned in
the descending aorta appropriately and catheter and balloon pump sutured
into place. The patient transferred for further care to ICU.
FINDINGS: Hemodynamic data: Rest AO of 120/78 mm Hg. LV 121/22 mm Hg.
No aortic valve gradient. Left ventricular angiogram was not performed due
to unknown renal function.
SELECTIVE CORONARY ANGIOGRAM: Left main coronary approximately 8
mm in length before bifurcating left anterior descending artery and left
circumflex coronary artery. Left anterior descending artery is a large vessel,
reaches the apex. It gives rise to large septal branch and distally the LAD
gives off a larger diagonal branch. There are left-to-right collaterals via
septal, which are faint. Left circumflex nondominant vessel, large vessel. The
AV groove branch is smaller. Large obtuse marginal branch. The left
circumflex and its branches angiographically normal. Right coronary artery
dominant vessel, large vessel, occluded proximally with TIMI 0 flow. After
establishing flow, there is a plaque rupture proximally. The mid RCA has an
eccentric 80 percent stenosis TIMI 2 to 3 flow. Distally the RCA has a
medium-sized posterolateral ventricular branch with luminal irregularities
and large posterior descending artery with mild luminal irregularities.

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