This patient is a 66-year-old male admitted on 6/19 because of unstable post-infarct angina. He underwent cardiac bypass surgery 15 years ago and did well until 1989 when he developed angina and underwent angioplasty with drug-eluting stents. On 6/9, he experienced severe chest pain and was taken to a nearby community hospital where he was found to have a small anterior wall ST elevation myocardial infarction, with the CPK only slightly elevated at 167. He was discharged from the hospital on June 10. Due to this small infarction, he was referred here. As the patient was walking from the vehicle to the office, he developed chest pain and was admitted to rule out further infarction.

**Hospital Course:**

He was taken to the cardiac catheterization laboratory. The skin and subcutaneous tissue were locally anesthetized. The right groin was prepped and draped using aseptic technique, and a coronary artery catheter was introduced over the guide wire. Arteriography of multiple coronary arteries and bypass visualization were performed. The complete heart catheterization showed severe hypokinesis of the left ventricle, although it did still move. The left main coronary artery had about 70 percent stenosis. The venous bypass graft to the left anterior descending artery had very severe stenosis. The autologous venous bypass graft to the circumflex looked good, but the body of the graft was narrowed.

Both of these previous bypass grafts were using autologous saphenous vein graft material. There was a very large circumflex artery that had an orificial 80 percent stenosis. It was decided he was not a candidate for angioplasty but should have bypass surgery.

He was seen in consultation by Dr. Reed, who agreed with this plan. He was taken to the operating room on the 21st. Using extracorporeal circulation and an open approach, the left internal mammary artery was anastomosed to the left anterior descending coronary artery, and a venous graft was placed from the aorta to the marginal circumflex. Prior to the procedure, a segment of the right greater saphenous vein was endoscopically harvested from the patient. It was found that the old venous graft to the main circumflex was in excellent condition with very soft, pliable walls, so that vessel was left intact.

There were no complications from this surgery. His postoperative course was uncomplicated. He never had any arrhythmia problems, and his wounds healed nicely. He had a tiny left pleural effusion that never needed to be tapped. He was walking about the ward participating in the cardiac rehab program at the time of discharge.

**Discharge Instructions:**

Discharge medications will be aspirin grains 59.d., Tylenol with Codeine 1 or 2 as needed for pain, Lopressor 50 mg a day, and Colace as necessary. He was instructed to contact his private physician upon returning home for the resumption of his medical care. He is to call me here at the medical center if there are any questions or problems he wishes to discuss.

**Discharge Diagnoses:**

1. Unstable angina (intermediate coronary syndrome)
2. Recent incomplete anterior wall myocardial infarction
3. Coronary atherosclerosis, three-vessel
4. Successful double-bypass surgery

What are the correct codes for this admission?

a. 125.110, 125.710, 121.09, 295.5, 021009W, 0210029, 06BP4ZZ, 5A12212, 4A023N7, B2151ZZ, B2111ZZ, B2131ZZ
b. 125.110, 125.710, 121.09, 295.1, 021109W, 06BP4ZZ, 5A1221Z, 4A023N7, B2151ZZ, B2111ZZ, B2131ZZ
c. 125.110, 125.710, N20.0, 122.0, 295.5, 021009W, 0210029, 06BP4ZZ, 5A1221A, 4A023N7, B2151ZZ, B2111ZZ, B2131ZZ
d. 125.110, 125.710, 125.2, 295.5, 295.1, 021009W, 0210029, 06BP4ZZ, 5A12212, 4A023N7, B21511Z, B2111ZZ, B2131ZZ