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1. Preparation

WHAT IS CORONARY ANGIOGRAPHY, ANGIOPLASTY/STENTS?

Coronary artery disease is a condition caused when a buildup of plaque, consisting of fatty deposits, cholesterol and calcium, stick to the walls of the arteries. This causes narrowing and blockages of the heart arteries, reducing the bloodflow to the heart. This in turn may cause clots that can result in a heart attack. The main risks factors for coronary artery disease are:

  • A diet that includes a large amount of saturated fats
  • Obesity
  • Smoking
  • Inactivity
  • Unstable diabetes
  • High blood pressure
  • High cholesterol
  • A family history of heart disease

angioplasty-01.gif

angioplasty-02.gif

Coronary Angiography:is a specialised x-ray that examines the blood vessels or chambers of your heart. It allows the cardiologist to have a look at the bloodflow to your heart and check for narrowing or blockages in the arteries. Artery blockages are the result of a build up of fatty deposits called plaque in the blood vessels. During a coronary angiography your cardiologist is also able to evaluate the blood pressure within your heart to ensure the blood is pumping correctly and monitor the functioning of your heart.

Angioplasty/Stents: An angioplasty is a procedure in which a special balloon is inserted to open the artery at the point of the blockage. This is done to improve the flow of blood to your heart. A stent is a flexible wire mesh tube that can be inserted into the expanded artery to maintain the cleared blockage.

Often an angiography and an angioplasty/stent are performed during the same procedure. However, this is dependent on the ability of your doctor and the way the hospital organises their procedure lists. Sometimes when a blockage is detected during angiography, you will be scheduled to have the stent inserted at a later date.

WHY IS IT DONE?

A coronary angiography is the most conclusive, although invasive diagnostic tool to diagnose suspected heart disease and determine the best treatment options based on the degree and number of blockages in the arteries.

An angioplasty widens (dilates) the blocked arteries whilst the stents (flexible wire mesh tubes) are inserted to keep the arteries open improving the flow of blood to the heart. The risk of having a heart attack is lessened considerably by restoring the bloodflow to the heart. It may also reduce the risk of arrhythmias (irregular heart rhythms) and heart failure.

HOW DO I CHOOSE A SPECIALIST?

Your GP or cardiologist will be able to recommend and refer you to an interventional cardiologist. You may be happy to accept their advice and recommendation, or you may like to investigate your choices; either option is safe and valid.

In Australia each medical speciality has a governing body to which the consultants belong – they are called ‘fellows’ of the college. These are often good organisations to turn to for information about what you can expect from your medical specialist. Unfortunately the cardiology site does not have a list of doctors or their areas of expertise

The list of questions below may help you to better understand your care, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website)

To access a list of Cardiologists who participate in HCF’s Medicover no gap arrangement:

  • Call HCF Member Services on 13 13 34
  • Visit one of HCF’s customer service branches
  • Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment. Some doctors who participate in the HCF Medicover no gap arrangement have chosen not to be listed on the HCF website. Therefore you will need to check with your doctor

WHAT SHOULD I ASK MY SPECIALIST?

  • Which facilities he/she operates in
  • Make sure you fully understand the procedure that is planned; do not be afraid to ask It is your right to know all the relevant information and associated costs, as this is part of informed clinical and financial consent. Once you are satisfied that you understand the procedure, your doctor will ask you to sign a consent form
  • If a blockage is found, what are your treatment options and if stenting can resolve the blockage, when will it be performed and can he/she perform this (not all cardiologists are interventional cardiologists)
  • Apart from what the procedure is about you should also ask about:
    • Preparation
    • The type of dye used (especially if you are prone to allergies)
    • Follow up appointments - jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
    • When you can drive
    • When you can lift heavy items
    • When you can resume your normal sexual activities
    • If you have difficulty lying on your back for a long time you need to discuss this with your doctor as you do need to lie still for several hours
  • Most medication should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medication you should stop, examples of medication that may require special instructions are:
    • Aspirin (or any related products),
    • Blood thinners (Warfarin, heparin.),
    • Arthritis medication,
    • Pain medication,
    • Insulin.

WHERE IS IT DONE?

The angiography or angioplasty is usually carried out as a day only procedure in a specialised day surgery or in a cardiac catheter laboratory (like an operating theatre) in a hospital. Should a stent(s) be inserted then an overnight stay in a hospital will be required.

HOW LONG IS THE PROCEDURE?

A routine angiography takes from 30-45 minutes.

Angioplasty/insertion of stents normally take anywhere from 30 minutes to several hours to perform, depending on the extent and location of the coronary artery disease.

WHO IS INVOLVED?

  • The interventional Cardiologist, your Specialist doctor
  • Nurses look after you throughout your admission
  • Radiologist for the necessary x-rays
  • Pathologist for the necessary blood tests

HOW DO I PREPARE FOR A CORONARY ANGIOGRAPHY, ANGIOPLASTY/STENTS?

Prior to either an Angiography or angioplasty/stent you will require the following tests:

  • Blood tests to assess your full blood count, electrolytes and kidney function (because of the dye used)
  • Electrocardiogram this checks the rhythm of your heart
  • Chest x-ray

You will normally be asked to stop eating and drinking approximately 6 hours prior to your procedure; midnight, the night prior to the procedure for a morning case or after a light early breakfast for an afternoon case.You may also be asked to stop taking some of your medication.

Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.

WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?

  • Do not bring any valuables with you
  • Leave all jewellery at home, a plain wedding ring is exempt
  • Wear comfortable clothing
  • Bring any medication that you would usually take during the day because under most circumstances you may still be able to take these
  • Dressing gown, slippers and toiletries in case you stay overnight
  • Remove all nail polish and do not wear any make-up
  • Labelled hard case for your glasses, labelled container for hearing aid or dentures if applicable

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

CORONARY ANGIOGRAPHY ADMISSIONS

For your information, the average charges for claims paid for Coronary Angiography admissions for the financial year 12/13 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $3,638

$0

$3,636
1 Medical Services Component
Cardio-Thoracic Surgical Services $926 $405 $509 $686 1.6% $0 98.4%
Diagnostic Procedures $46 $25 $20 $24 3.2% $0 96.8%
Pathology Services $105 $50 $37 $71 25.2% $0 74.8%
Specialist Consultation $130 $61 $67 $58 1.9% $0 98.1%
Radiology Services $533 $276 $248 $183 4.1% $0 95.9%
2 Total Average Medical Services $1,590 $745 $817 $220 11.5% $0 88.5%
Hospital and Medical Services Average for Coronary Angiography Admissions $5,228 $745 $4,453 $220 11.5% $0 5 88.5%

Coronary Angiography FY13.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 1,845 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 38215 and 38218.
  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
  • There is no excess payable for same day admissions.

1 These medical services are in-patient services only.

2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here. Therefore, the total average medical service charge ($1,590) differs from the sum of the individual average charges as shown.

3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

5 This percentage indicates the total coverage of hospital and medical services for all coronary angiography admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

CORONARY ANGIOGRAPHY WITH INSERTION OF STENT ADMISSIONS

For your information, the average charges for claims paid for Coronary Angiography with Insertion of Stent admissions for the financial year 12/13 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $18,006 $0 $17,870
1 Medical Services Component
Cardio-Thoracic Surgical Services $1,993 $1,022 $939 $879 2.6% $0 97.4%
Pathology Services $216 $109 $89 $143 12.1% $0 87.9%
Specialist Consultation $382 $206 $163 $235 5.0% $0 95.0%
Radiology $700 $367 $314 $178 10.4% $0 89.6%
Vascular Surgical Services $612 $356 $172 $424 20.0% $0 80.0%
2 Total Average Medical Services $2,954 $1,531 $1,351 $337 18.7% $0 81.3%
Hospital and Medical Services Average for Coronary Angiography with Insertion of Stent Admissions $20,960 $1,531 $19,221 $337 18.7% $0 5 81.3%

Coronary Angiography, Angioplasty & Stents FY13.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 1,282 overnight admissions with an average length of stay of 2.5 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 38246 and 38306.
  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

1 These medical services are in-patient services only.

2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. diagnostic procedures. Therefore, the total average medical service charge ($2,954) differs from the sum of the individual average charges as shown.

3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

5 This percentage indicates the total coverage of hospital and medical services for all coronary angiography with insertion of stent admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

2. Day of procedure

WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?

When you arrive at the hospital or day surgery, the admissions clerk will attend to the paperwork associated with your stay. On admission to the hospital/day surgery a nurse will orientate you to your surroundings and request your medical history, current medication, any known allergies and for you to empty your bladder. Your surgeon will talk you through the operation, explaining any potential risks and side effects, and ask you to sign a form to indicate you understand and give your consent to the procedure (for elective procedures this is usually completed in the doctor’s rooms).

Once the admission process is completed, you will normally be taken to the procedure room where you will be given a gown to change into. At this time you may be given a mild sedative to help you relax and both sides of your groin may be shaved and electrodes (dots) placed on your chest to connect up the cardiac monitor. An intravenous drip will be inserted and you will then be taken to theatre. You will be covered with theatre drapes that may make you feel a little warm. As the catheter lab is a theatre, the lights are quite bright and it can be noisy with the buzzing of the machines.

WHAT CAN I EXPECT DURING THE PROCEDURES?

Coronary Angiography – You will be given a local anaesthetic so you will be awake throughout the procedure so you can see the progress of the dye if you wish. Throughout the procedure you may be asked to follow some instructions such as, take a deep breath, hold your breath, cough or raise your arm. A sheath is inserted into the main (femoral) artery of the groin. Rarely the catheter will be fed through a sheath placed in the brachial artery inside your elbow.

A thin flexible tube called a catheter is fed in and guided through the aorta, which is the body’s main artery. Once this reaches the coronary arteries, a special radio opaque dye is injected into the arteries and the left ventricle of the heart. As the dye is injected you may feel a brief sensation of flushing or warmth lasting about 10-15 seconds.

As the dye moves through, x-ray pictures are taken and you may feel your heart miss a few beats. Don’t worry, as the cardiac team are monitoring your heart at all times. If you feel chest pain or chest discomfort let the staff know. These pictures provide a map of the coronary arteries that will assist the cardiologist in identifying any narrowing or blockages in the arteries and how well your heart (left ventricle) is functioning.

If the tests show blockages or a narrowing of the arteries, it may be treated straight away with an angioplasty and stent(s). At the time of discussing and consenting for the angiography, your doctor would have also discussed the possibility of immediately treating any blockages found by stent insertion and, should have included angioplasty/stent on your original consent form.

Coronary Angioplasty/Stents – A tiny angioplasty balloon is inserted via the catheter and into the narrowed artery. The balloon is then inflated and left for a few minutes. This stretches and widens the artery, pushing the materials causing the blockage to the walls of the artery. This increases the flow of blood to the heart. Whilst the balloon is inflated you may experience some chest pain. This dilatation may be repeated several times if there is more then one blockage in a coronary artery or if several arteries are blocked.

When the balloon is deflated, if the blockage recurs or the cardiologist feels there is a possibility of the blockage returning, a coronary stent will be inserted.

The stent is a flexible metal coil tube that is inserted using the balloon catheter. When the balloon is inflated into the blocked artery, the stent expands, propping open the artery and stays in place even after the balloon is deflated and removed. Some stents (drug eluting) are coated with medication that is slowly released helping to keep the artery open.

3. Aftercare

WHAT HAPPENS AFTER THE PROCEDURE?

Coronary Angiography – You will be taken to the recovery room after your procedure where the sheath that was placed in your groin is removed. The artery, the tube passes through, is a large vessel and it is important to establish good haemastasis (no bleeding). To achieve this the nurse will apply pressure on the artery for about 10-15 minutes, then apply a pressure device for a period of time, which will be closely monitored. Sometimes, the vessel will be closed with a suture at the time of removing the tube. Either way you will be required to lie flat for up to two hours with your leg straight, reducing the chance of bleeding or bruising. You will then be allowed to sit up and for the next couple of hours it is very important you drink plenty of fluids to help flush the dye through the kidneys. The doctor performing the angiography will usually discuss the preliminary results with you prior to discharge and send a report to your cardiologist (if different doctor) and your GP, and also inform you if you need to make a follow up appointment with him/her.

Coronary Angioplasty/Stents – If you are required to have an angioplasty/stent, you will have an overnight admission. This may be in a Cardiac ward or in a Coronary Care Unit depending on the hospital policy and cardiologist's instructions. The first few hours you will be closely observed, having your groin checked as above, your observations taken frequently and your heart rhythm monitored. You are kept on bed rest for 6-8 hours as a guide but each cardiologist and hospital will have their own policy. During the first 2- 6 hours (approximately) you will be required to lay on your back with the affected limb kept straight. This can be uncomfortable and you should ask for pain relief if this becomes too uncomfortable.

Before you are discharged, you are usually seen by a nurse educator who will discuss heart disease and managing your risk factors, what activities you can do and when, and discuss your medication. You will also be given information about cardiac rehabilitation programs available either at the treating hospital or somewhere close to where you live. Whilst it is not compulsory to attend they are valuable in helping you understand your disease and moving forward. You will be discharged on anticoagulant medication (reduce risk of clot formation). These may be continued indefinitely and stopping them may increase your risk of a heart attack, so please follow your doctor’s instructions explicitly. Your doctor will see you and explain the results of the tests before your discharge.

Your doctor will have his/her own discharge instructions but in most cases, once you are at home, it is advisable that you lie down and rest, legs raised slightly, for the remainder of the day. For the next five days heavy lifting or over-exertion should be avoided.

You should contact your doctor immediately if any of the following symptoms are experienced:

  • Bleeding
  • Discoloration or pain in the leg
  • Chills or shaking
  • Fever
  • Signs of infection

1. Preparation

WHAT IS CORONARY ANGIOGRAPHY, ANGIOPLASTY/STENTS?

Coronary artery disease is a condition caused when a buildup of plaque, consisting of fatty deposits, cholesterol and calcium, stick to the walls of the arteries. This causes narrowing and blockages of the heart arteries, reducing the bloodflow to the heart. This in turn may cause clots that can result in a heart attack. The main risks factors for coronary artery disease are:

  • A diet that includes a large amount of saturated fats
  • Obesity
  • Smoking
  • Inactivity
  • Unstable diabetes
  • High blood pressure
  • High cholesterol
  • A family history of heart disease

angioplasty-01.gif

angioplasty-02.gif

Coronary Angiography:is a specialised x-ray that examines the blood vessels or chambers of your heart. It allows the cardiologist to have a look at the bloodflow to your heart and check for narrowing or blockages in the arteries. Artery blockages are the result of a build up of fatty deposits called plaque in the blood vessels. During a coronary angiography your cardiologist is also able to evaluate the blood pressure within your heart to ensure the blood is pumping correctly and monitor the functioning of your heart.

Angioplasty/Stents: An angioplasty is a procedure in which a special balloon is inserted to open the artery at the point of the blockage. This is done to improve the flow of blood to your heart. A stent is a flexible wire mesh tube that can be inserted into the expanded artery to maintain the cleared blockage.

Often an angiography and an angioplasty/stent are performed during the same procedure. However, this is dependent on the ability of your doctor and the way the hospital organises their procedure lists. Sometimes when a blockage is detected during angiography, you will be scheduled to have the stent inserted at a later date.

WHY IS IT DONE?

A coronary angiography is the most conclusive, although invasive diagnostic tool to diagnose suspected heart disease and determine the best treatment options based on the degree and number of blockages in the arteries.

An angioplasty widens (dilates) the blocked arteries whilst the stents (flexible wire mesh tubes) are inserted to keep the arteries open, thus improving the flow of blood to the heart. The risk of having a heart attack is lessened considerably by restoring the bloodflow to the heart. It may also reduce the risk of arrhythmias (irregular heart rhythms) and heart failure.

HOW DO I CHOOSE A SPECIALIST?

Your GP or cardiologist will be able to recommend and refer you to an interventional cardiologist. You may be happy to accept their advice and recommendation, or you may like to investigate your choices; either option is safe and valid.

In Australia each medical speciality has a governing body to which the consultants belong – they are called ‘fellows’ of the college. These are often good organisations to turn to for information about what you can expect from your medical specialist. Unfortunately the cardiology site does not have a list of doctors or their areas of expertise

The list of questions below may help you to better understand your care, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website)

To access a list of Cardiologists who participate in HCF’s Medicover no gap arrangement:

  • Call HCF Member Services on 13 13 34
  • Visit one of HCF’s customer service branches
  • Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment. Some doctors who participate in the HCF Medicover no gap arrangement have chosen not to be listed on the HCF website. Therefore you will need to check with your doctor

WHAT SHOULD I ASK MY SPECIALIST?

  • Which facilities he/she operates in
  • Make sure you fully understand the procedure that is planned; do not be afraid to ask It is your right to know all the relevant information and associated costs, as this is part of informed clinical and financial consent. Once you are satisfied that you understand the procedure, your doctor will ask you to sign a consent form
  • If a blockage is found, what are your treatment options and if stenting can resolve the blockage, when will it be performed and can he/she perform this (not all cardiologists are interventional cardiologists)
  • Apart from what the procedure is about you should also ask about:
    • Preparation
    • The type of dye used (especially if you are prone to allergies)
    • Follow up appointments - jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
    • When you can drive
    • When you can lift heavy items
    • When you can resume your normal sexual activities
    • If you have difficulty lying on your back for a long time you need to discuss this with your doctor as you do need to lie still for several hours
  • Most medication should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medication you should stop, examples of medication that may require special instructions are:
    • Aspirin (or any related products),
    • Blood thinners (Warfarin, heparin.),
    • Arthritis medication,
    • Pain medication,
    • Insulin.

WHERE IS IT DONE?

The angiography or angioplasty is usually carried out as a day only procedure in a specialised day surgery or in a cardiac catheter laboratory (like an operating theatre) in a hospital. Should a stent(s) be inserted then an overnight stay in a hospital will be required.

HOW LONG IS THE PROCEDURE?

A routine angiography takes from 30-45 minutes.

Angioplasty/insertion of stents normally take anywhere from 30 minutes to several hours to perform, depending on the extent and location of the coronary artery disease.

WHO IS INVOLVED?

  • The interventional Cardiologist, your Specialist doctor
  • Nurses look after you throughout your admission
  • Radiologist for the necessary x-rays
  • Pathologist for the necessary blood tests

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

CORONARY ANGIOGRAPHY ADMISSIONS

For your information, the average charges for claims paid for Coronary Angiography admissions for the financial year 12/13 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $3,638

$0

$3,636
1 Medical Services Component
Cardio-Thoracic Surgical Services $926 $405 $509 $686 1.6% $0 98.4%
Diagnostic Procedures $46 $25 $20 $24 3.2% $0 96.8%
Pathology Services $105 $50 $37 $71 25.2% $0 74.8%
Specialist Consultation $130 $61 $67 $58 1.9% $0 98.1%
Radiology Services $533 $276 $248 $183 4.1% $0 95.9%
2 Total Average Medical Services $1,590 $745 $817 $220 11.5% $0 88.5%
Hospital and Medical Services Average for Coronary Angiography Admissions $5,228 $745 $4,453 $220 11.5% $0 5 88.5%

Coronary Angiography FY13.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 1,845 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 38215 and 38218.
  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
  • There is no excess payable for same day admissions.

1 These medical services are in-patient services only.

2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here. Therefore, the total average medical service charge ($1,590) differs from the sum of the individual average charges as shown.

3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

5 This percentage indicates the total coverage of hospital and medical services for all coronary angiography admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

CORONARY ANGIOGRAPHY WITH INSERTION OF STENT ADMISSIONS

For your information, the average charges for claims paid for Coronary Angiography with Insertion of Stent admissions for the financial year 12/13 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $18,006 $0 $17,870
1 Medical Services Component
Cardio-Thoracic Surgical Services $1,993 $1,022 $939 $879 2.6% $0 97.4%
Pathology Services $216 $109 $89 $143 12.1% $0 87.9%
Specialist Consultation $382 $206 $163 $235 5.0% $0 95.0%
Radiology $700 $367 $314 $178 10.4% $0 89.6%
Vascular Surgical Services $612 $356 $172 $424 20.0% $0 80.0%
2 Total Average Medical Services $2,954 $1,531 $1,351 $337 18.7% $0 81.3%
Hospital and Medical Services Average for Coronary Angiography with Insertion of Stent Admissions $20,960 $1,531 $19,221 $337 18.7% $0 5 81.3%

Coronary Angiography, Angioplasty & Stents FY13.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 1,282 overnight admissions with an average length of stay of 2.5 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 38246 and 38306.
  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

1 These medical services are in-patient services only.

2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. diagnostic procedures. Therefore, the total average medical service charge ($2,954) differs from the sum of the individual average charges as shown.

3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

5 This percentage indicates the total coverage of hospital and medical services for all coronary angiography with insertion of stent admissions. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

HOW DO I PREPARE FOR A CORONARY ANGIOGRAPHY, ANGIOPLASTY/STENTS?

Prior to either an Angiography or angioplasty/stent you will require the following tests:

  • Blood tests to assess your full blood count, electrolytes and kidney function (because of the dye used)
  • Electrocardiogram this checks the rhythm of your heart
  • Chest x-ray

You will normally be asked to stop eating and drinking approximately 6 hours prior to your procedure; midnight, the night prior to the procedure for a morning case or after a light early breakfast for an afternoon case.You may also be asked to stop taking some of your medication.

Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.

WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?

  • Do not bring any valuables with you
  • Leave all jewellery at home, a plain wedding ring is exempt
  • Wear comfortable clothing
  • Bring any medication that you would usually take during the day because under most circumstances you may still be able to take these
  • Dressing gown, slippers and toiletries in case you stay overnight
  • Remove all nail polish and do not wear any make-up
  • Labelled hard case for your glasses, labelled container for hearing aid or dentures if applicable

2. Day of procedure

WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?

When you arrive at the hospital or day surgery, the admissions clerk will attend to the paperwork associated with your stay. On admission to the hospital/day surgery a nurse will orientate you to your surroundings and request your medical history, current medication, any known allergies and for you to empty your bladder. Your surgeon will talk you through the operation, explaining any potential risks and side effects, and ask you to sign a form to indicate you understand and give your consent to the procedure (for elective procedures this is usually completed in the doctor’s rooms).

Once the admission process is completed, you will normally be taken to the procedure room where you will be given a gown to change into. At this time you may be given a mild sedative to help you relax and both sides of your groin may be shaved and electrodes (dots) placed on your chest to connect up the cardiac monitor. An intravenous drip will be inserted and you will then be taken to theatre. You will be covered with theatre drapes that may make you feel a little warm. As the catheter lab is a theatre, the lights are quite bright and it can be noisy with the buzzing of the machines.

WHAT CAN I EXPECT DURING THE PROCEDURES?

Coronary Angiography – You will be given a local anaesthetic so you will be awake throughout the procedure so you can see the progress of the dye if you wish. Throughout the procedure you may be asked to follow some instructions such as, take a deep breath, hold your breath, cough or raise your arm. A sheath is inserted into the main (femoral) artery of the groin. Rarely the catheter will be fed through a sheath placed in the brachial artery inside your elbow.

A thin flexible tube called a catheter is fed in and guided through the aorta, which is the body’s main artery. Once this reaches the coronary arteries, a special radio opaque dye is injected into the arteries and the left ventricle of the heart. As the dye is injected you may feel a brief sensation of flushing or warmth lasting about 10-15 seconds.

As the dye moves through, x-ray pictures are taken and you may feel your heart miss a few beats. Don’t worry, as the cardiac team are monitoring your heart at all times. If you feel chest pain or chest discomfort let the staff know. These pictures provide a map of the coronary arteries that will assist the cardiologist in identifying any narrowing or blockages in the arteries and how well your heart (left ventricle) is functioning.

If the tests show blockages or a narrowing of the arteries, it may be treated straight away with an angioplasty and stent(s). At the time of discussing and consenting for the angiography, your doctor would have also discussed the possibility of immediately treating any blockages found by stent insertion and, should have included angioplasty/stent on your original consent form.

Coronary Angioplasty/Stents – A tiny angioplasty balloon is inserted via the catheter and into the narrowed artery. The balloon is then inflated and left for a few minutes. This stretches and widens the artery, pushing the materials causing the blockage to the walls of the artery. This increases the flow of blood to the heart. Whilst the balloon is inflated you may experience some chest pain. This dilatation may be repeated several times if there is more then one blockage in a coronary artery or if several arteries are blocked.

When the balloon is deflated, if the blockage recurs or the cardiologist feels there is a possibility of the blockage returning, a coronary stent will be inserted.

The stent is a flexible metal coil tube that is inserted using the balloon catheter. When the balloon is inflated into the blocked artery, the stent expands, propping open the artery, and stays in place even after the balloon is deflated and removed. Some stents (drug eluting) are coated with medication that is slowly released helping to keep the artery open.

3. Aftercare

WHAT HAPPENS AFTER THE PROCEDURE?

Coronary Angiography – You will be taken to the recovery room after your procedure where the sheath that was placed in your groin is removed. The artery, the tube passes through, is a large vessel and it is important to establish good haemastasis (no bleeding). To achieve this the nurse will apply pressure on the artery for about 10-15 minutes, then apply a pressure device for a period of time, which will be closely monitored. Sometimes, the vessel will be closed with a suture at the time of removing the tube. Either way you will be required to lie flat for up to two hours with your leg straight, reducing the chance of bleeding or bruising. You will then be allowed to sit up and for the next couple of hours it is very important you drink plenty of fluids to help flush the dye through the kidneys. The doctor performing the angiography will usually discuss the preliminary results with you prior to discharge and send a report to your cardiologist (if different doctor) and your GP and also inform you if you need to make a follow up appointment with him/her.

Coronary Angioplasty/Stents – If you are required to have an angioplasty/stent, you will have an overnight admission. This may be in a Cardiac ward or in a Coronary Care Unit depending on the hospital policy and cardiologist's instructions. The first few hours you will be closely observed, having your groin checked as above, your observations taken frequently and your heart rhythm monitored. You are kept on bed rest for 6-8 hours as a guide but each cardiologist and hospital will have their own policy. During the first 2- 6 hours (approximately) you will be required to lay on your back with the affected limb kept straight. This can be uncomfortable and you should ask for pain relief if this becomes too uncomfortable.

Before you are discharged, you are usually seen by a nurse educator who will discuss heart disease and managing your risk factors, what activities you can do and when, and discuss your medication. You will also be given information about cardiac rehabilitation programs available either at the treating hospital or somewhere close to where you live. Whilst it is not compulsory to attend they are valuable in helping you understand your disease and moving forward. You will be discharged on anticoagulant medication (reduce risk of clot formation). These may be continued indefinitely and stopping them may increase your risk of a heart attack, so please follow your doctor’s instructions explicitly. Your doctor will see you and explain the results of the tests before your discharge.

Your doctor will have his/her own discharge instructions but in most cases, once you are at home, it is advisable that you lie down and rest, legs raised slightly, for the remainder of the day. For the next five days heavy lifting or over-exertion should be avoided.

You should contact your doctor immediately if any of the following symptoms are experienced:

  • Bleeding
  • Discoloration or pain in the leg
  • Chills or shaking
  • Fever
  • Signs of infection
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Disclaimer: Information is provided by HCF in good faith for the convenience of members. It is not an endorsement or recommendation of any form of treatment, nor is it a substitute for medical advice, and you should rely on the advice of your treating doctors in relation to all matters concerning your health. Every effort has been taken to ensure the accuracy of this information, however, HCF takes no responsibility for any injury, loss, damage or other consequence of the use of this information.