bhargavi
Guru
Procedures performed:
Description of procedure: patient was brought to angio suite and identified using multiple patient identifiers. Time out was performed by entire team. Patient was placed in supine position on angiography table and bilateral ground and right wrist was cleaned using beta fine solution. Sterile drape was applied. Right femoral artery was palpated and under ultrasound 5 French sheath was placed using micro puncture kit and modified Seldinger technique. This was sutured and continuously flushed with pressurized heroism saline. A 5 French Simms 2 catheter was continuously flushed with heparinized swine and was then navigated over 0.035 guidewire up to arch of sorts where it was reconstituted and following blood vessels were catheterized- Right common, right internal, left common, left internal, left subclavian, left vertebral artery, right subclavian, right vertebral artery. The angiogram was analyzed and subsequently removed from the body without any incident. Patient was examined without any neurological deficits and femoral sheath was removed and angioseal was deployed Complications - None Disposition- patient sent back to ambulatory surgery care for further monitoring Interpretation : Right common carotid artery angiogram: Right common carotid artery angiogram demonstrates normal appearing common carotid artery. Right common carotid artery bifurcates at c3 cervical vertebrae. The bifurcation of Right common carotid artery appears normal. It bifurcates into Right internal carotid artery and Right External carotid artery. Origin of Right internal carotid artery shows mild atherosclerosis disease without any evidence of stenosis. The external carotid artery appears normal with normal appearing branches of right external carotid artery.The capillary, tissue and venous phase of above mentioned arteries appears normal. Right Internal carotid artery angiogram, neck and head - Right internal carotid artery demonstrates normal appearing cervical segment of right internal carotid artery.The cervical segment continues into right petrous segment and cavernous segment of right internal carotid artery. The petrous and cavernous segment appears normal with no major hemodynamic stenosis. The cavernous segment continues into ophthalmic segment. The ophthalmic artery appears normal in shape and caliber. The terminus portion of right internal carotid artery bifurcates into right middle cerebral artery and right anterior cerebral artery. The right middle cerebral M1 segment appears normal. The Middle cerebra artery divides into the superior and inferior segment which also appears normal. The terminal segment of middle cerebral arteries appears normal. The Anterior cerebral artery A1 segment and A2 segment also appear normal. On lateral view of angiogram pericallosal and callosomarginal arteries can be seen. The capillary, tissues and venous phase of all the above arteries appears normal. Left common carotid artery angiogram: Left common carotid artery angiogram demonstrates normal appearing common carotid artery. The Left common carotid artery bifurcates at c3 cervical vertebrae. The bifurcation of Left common carotid artery appears normal. It bifurcates into Left internal carotid artery and Left External carotid artery. Origin of Left internal carotid artery appears normal without any evidence of stenosis. The external carotid artery appears normal with normal appearing branches of right external carotid artery.The capillary, tissue and venous phase of above mentioned arteries appears normal. Left Internal carotid artery angiogram, neck and head - Left internal carotid artery demonstrates normal appearing cervical segment of internal carotid artery. There appears to be 360 degree loop at proximal portion of left internal carotid artery.The cervical segment continues into petrous segment and cavernous segment of left internal carotid artery. The petrous and cavernous segment appears normal with no major hemodynamic stenosis. The cavernous segment continues into ophthalmic segment. The ophthalmic artery appears normal in shape and caliber. The terminus portion of left internal carotid artery bifurcates into right middle cerebral artery and right anterior cerebral artery. The left middle cerebral M1 segment appears normal. The left A1 and A2 segments also appears normal with normal appearing pericallosal and callosomarginal arteries. Left subclavian artery angiogram - Angiogram from proximal Subclavian artery demonstrates normal appearing subclavian artery with no stenosis. The vertebral artery origin appears normal except just distal to origin there appears to be around 40% stenosis as per NASCET criteria of vertebral artery. The other branches of subclavian artery like Thyrocervical, internal thoracic artery,Transverese cervical and suprascapular artery appears normal. Left vertebral artery angiogram- Left vertebral artery angiogram demonstrates normal appearing angiogram of left vertebral artery except around 40% stenosis distal to origin of left vertebral artery. The V1 and V2 segment appears normal. The left vertebral artery VB junction appears normal with normal appearing PICA (posterior inferior cerebellar artery). Basilar artery appears normal with normal appearing bilateral AICA. The basilar artery ends in bilateral PCA. The bilateral PCA(posterior cerebral arteries) appears normal in shape and caliber. Right subclavian artery angiogram - Angiogram from proximal Subclavian artery demonstrates normal appearing subclavian artery with no stenosis. The vertebral artery origin appears to have around 71% stenosis just 8mm distal from origin of right vertebral artery. The post stenotic portion of right vertebral artery appears normal along with other branches of subclavian like Thyrocervical, internal thoracic artery,Transverese cervical and suprascapular artery. Right vertebral artery angiogram- Right vertebral artery angiogram demonstrates around 71% stenosis of right vertebral artery at around 8mm distal to origin . The rest of vertebral artery appears normal . The V1 and V2 segment appears normal. The vertebral artery VB junction appears normal with normal appearing PICA (posterior inferior cerebellar artery)on right. Basilar artery appears normal with normal appearing bilateral AICA. The basilar artery ends in bilateral PCA. The capillary, tissue and venous phase all appears normal. Right common femoral artery angiogram- Right CFA angiogram demonstrate normal appearing right CFA proximally with normal bifurcation. The site of arteriotomy appears well above bifurcation of CFA. thanks in adance I am hospital coder should I do 36224-50, 36225-50, xs, 36226-50? or should I add 75710 for cfa? I understand as 36222 and 36223 will be bundled into 36224- am I understanding correctly? and each 36- codes are mue -1 per date of service per nthrive for outpatient so what does this mean? I can bill bilateral on one day or no? |
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