bhargavi
Guru
Conclusion
PROCEDURES
1. Abdominal aortogram
2. Bilateral lower extremity angiogram with runoff
3. Percutaneous intervention of proximal, mid, and distal right SFA using Eluvia drug-eluting stents. Drug-coated balloon angioplasty of right popliteal artery and force balloon angioplasty of right TPT trunk/peroneal artery.
4. Manual pressure was held at left femoral artery access site due to significant stenosis in the left common femoral artery.
PROCEDURE NOTE
Informed consent was obtained after explaining risks and benefits to the patient. Left groin was draped and prepped in the sterile fashion. Patient was premedicated with fentanyl and Versed. After injecting 2% lidocaine in the left groin, left common femoral artery was accessed using micropuncture needle and a 5 French sheath was inserted without any difficulty. 5 French IM catheter was advanced and abdominal aortogram was performed. With the help of 0.035 zip wire bifurcation of the aorta was successfully crossed. Right lower extremity angiogram was performed. Patient was proceeded with intervention of the right proximal, mid, distal SFA, popliteal artery, TPT trunk/peroneal artery. Patient remained hemodynamically stable and tolerated procedure well. Patient was stable without any discomfort at the procedure.
I attest that moderate conscious sedation was provided under my direct supervision with the sedation trained nurse using 1 mg of intravenous Versed and 50 mcg of fentanyl to sedate the patient. Start time 9:52 AM and end time was 11:26 AM. There were no complications. See nurse's sedation sheet, for complete pre-and post service details.
ABDOMINAL AORTOGRAM
Abdominal aorta was patent without dilatation or aneurysm.
RIGHT LOWER EXTREMITY ANGIOGRAM
Common iliac artery was patent. Right external iliac artery was patent. Internal iliac was patent. Common femoral artery was patent. Superficial femoral artery was diffusely diseased with multiple areas of 80 to 90% stenosis throughout the entire segment. Popliteal artery was patent. Tibial peroneal trunk was patent with diffuse disease. Anterior tibial artery was patent. Posterior tibial artery was patent. Peroneal artery was patent with moderate to severe disease in the proximal segment and mild diffuse disease in the distal segment.
LEFT LOWER EXTREMITY ANGIOGRAM
Common iliac artery was patent. Left external iliac artery was patent. Internal iliac was patent. Common femoral artery has severe diffuse disease. Superficial femoral artery was severely diseased with subtotal occlusion extending into the mid segment. Distal SFA was patent. Popliteal artery was patent with moderate to severe diffuse disease. Tibioperoneal trunk has severe diffuse disease. Anterior tibial artery was patent with diffuse disease. Posterior tibial artery was patent. Peroneal artery was patent with diffuse disease.
PERCUTANEOUS INTERVENTION OF
6 French 45 cm destination sheath was advanced over a Magic torque wire and the proximal end of the sheath was placed in the right common femoral artery. 70 units/kg heparin was used for anticoagulation. 0.035 Rubicon catheter was advanced over a Magic torque wire and wire was removed and exchanged for Terumo run-through 300 cm wire which was placed in the distal peroneal artery. Force balloon angioplasty of TP trunk and peroneal artery was performed using Sterling 3.0 x 150 mm balloon. Subsequent angiogram revealed improvement in flow with small area of dissection which was nonflow-limiting. Shockwave M5 IVR 5.0 x 60 mm balloon was advanced into distal SFA and lithotripsy was performed for 5 minutes. Subsequent angiogram revealed significant improvement in the lesion of the distal superficial femoral artery without perforation or significant dissection and a brisk antegrade flow. Next, entire SFA was treated with Sterling 5.0 x 220 mm balloon with significant improvement in the lesion. There were 2 areas of resistant lesions noted and mid and distal SFA which were treated with angiosculpt 5.0 x 40 mm cutting balloon. Next, peroneal artery dissection was treated with Sterling 2.5 x 80 mm balloon which was inflated for approximately 3 minutes. Slight improvement in dissection flap was noted. Again, this was nonflow limiting with TIMI-3 flow in the distal segment. Next, Eluvia 6 x 120 mm, 6 x 120 mm, and 6 x 120 mm stents were deployed from proximal to distal SFA in overlapping fashion. Entire stent length was postdilated using Sterling 5.0 x 220 mm balloon. Follow-up angiogram revealed significant improvement in stenosis and flow without evidence of dissection or perforation. There was slight disruption of plaque noted at the distal end of the stent. This was treated with Ranger 4.0 x 40 mm drug-coated balloon. Follow-up angiogram revealed improvement in flow without evidence of dissection or perforation. Procedure was concluded at this point. Final ACT was measured at 272. Patient received 300 mg of Plavix. Sheath will be removed in the holding area with manual compression held at the site.
IMPRESSION
1. Severe bilateral peripheral arterial disease.
2. Status post percutaneous intervention using 3 drug-eluting stents in the right proximal to distal SFA, drug-coated balloon angioplasty of right popliteal artery, and force balloon angioplasty of TP trunk/peroneal artery
thanks in advance
i am coming up with C9765, 37228 rt, 75716. am i correct? i am hospital coder
and also what does physician codes as?
PROCEDURES
1. Abdominal aortogram
2. Bilateral lower extremity angiogram with runoff
3. Percutaneous intervention of proximal, mid, and distal right SFA using Eluvia drug-eluting stents. Drug-coated balloon angioplasty of right popliteal artery and force balloon angioplasty of right TPT trunk/peroneal artery.
4. Manual pressure was held at left femoral artery access site due to significant stenosis in the left common femoral artery.
PROCEDURE NOTE
Informed consent was obtained after explaining risks and benefits to the patient. Left groin was draped and prepped in the sterile fashion. Patient was premedicated with fentanyl and Versed. After injecting 2% lidocaine in the left groin, left common femoral artery was accessed using micropuncture needle and a 5 French sheath was inserted without any difficulty. 5 French IM catheter was advanced and abdominal aortogram was performed. With the help of 0.035 zip wire bifurcation of the aorta was successfully crossed. Right lower extremity angiogram was performed. Patient was proceeded with intervention of the right proximal, mid, distal SFA, popliteal artery, TPT trunk/peroneal artery. Patient remained hemodynamically stable and tolerated procedure well. Patient was stable without any discomfort at the procedure.
I attest that moderate conscious sedation was provided under my direct supervision with the sedation trained nurse using 1 mg of intravenous Versed and 50 mcg of fentanyl to sedate the patient. Start time 9:52 AM and end time was 11:26 AM. There were no complications. See nurse's sedation sheet, for complete pre-and post service details.
ABDOMINAL AORTOGRAM
Abdominal aorta was patent without dilatation or aneurysm.
RIGHT LOWER EXTREMITY ANGIOGRAM
Common iliac artery was patent. Right external iliac artery was patent. Internal iliac was patent. Common femoral artery was patent. Superficial femoral artery was diffusely diseased with multiple areas of 80 to 90% stenosis throughout the entire segment. Popliteal artery was patent. Tibial peroneal trunk was patent with diffuse disease. Anterior tibial artery was patent. Posterior tibial artery was patent. Peroneal artery was patent with moderate to severe disease in the proximal segment and mild diffuse disease in the distal segment.
LEFT LOWER EXTREMITY ANGIOGRAM
Common iliac artery was patent. Left external iliac artery was patent. Internal iliac was patent. Common femoral artery has severe diffuse disease. Superficial femoral artery was severely diseased with subtotal occlusion extending into the mid segment. Distal SFA was patent. Popliteal artery was patent with moderate to severe diffuse disease. Tibioperoneal trunk has severe diffuse disease. Anterior tibial artery was patent with diffuse disease. Posterior tibial artery was patent. Peroneal artery was patent with diffuse disease.
PERCUTANEOUS INTERVENTION OF
6 French 45 cm destination sheath was advanced over a Magic torque wire and the proximal end of the sheath was placed in the right common femoral artery. 70 units/kg heparin was used for anticoagulation. 0.035 Rubicon catheter was advanced over a Magic torque wire and wire was removed and exchanged for Terumo run-through 300 cm wire which was placed in the distal peroneal artery. Force balloon angioplasty of TP trunk and peroneal artery was performed using Sterling 3.0 x 150 mm balloon. Subsequent angiogram revealed improvement in flow with small area of dissection which was nonflow-limiting. Shockwave M5 IVR 5.0 x 60 mm balloon was advanced into distal SFA and lithotripsy was performed for 5 minutes. Subsequent angiogram revealed significant improvement in the lesion of the distal superficial femoral artery without perforation or significant dissection and a brisk antegrade flow. Next, entire SFA was treated with Sterling 5.0 x 220 mm balloon with significant improvement in the lesion. There were 2 areas of resistant lesions noted and mid and distal SFA which were treated with angiosculpt 5.0 x 40 mm cutting balloon. Next, peroneal artery dissection was treated with Sterling 2.5 x 80 mm balloon which was inflated for approximately 3 minutes. Slight improvement in dissection flap was noted. Again, this was nonflow limiting with TIMI-3 flow in the distal segment. Next, Eluvia 6 x 120 mm, 6 x 120 mm, and 6 x 120 mm stents were deployed from proximal to distal SFA in overlapping fashion. Entire stent length was postdilated using Sterling 5.0 x 220 mm balloon. Follow-up angiogram revealed significant improvement in stenosis and flow without evidence of dissection or perforation. There was slight disruption of plaque noted at the distal end of the stent. This was treated with Ranger 4.0 x 40 mm drug-coated balloon. Follow-up angiogram revealed improvement in flow without evidence of dissection or perforation. Procedure was concluded at this point. Final ACT was measured at 272. Patient received 300 mg of Plavix. Sheath will be removed in the holding area with manual compression held at the site.
IMPRESSION
1. Severe bilateral peripheral arterial disease.
2. Status post percutaneous intervention using 3 drug-eluting stents in the right proximal to distal SFA, drug-coated balloon angioplasty of right popliteal artery, and force balloon angioplasty of TP trunk/peroneal artery
thanks in advance
i am coming up with C9765, 37228 rt, 75716. am i correct? i am hospital coder
and also what does physician codes as?