Go Back   AAPC Medical Coding & Billing Forums > Medical Coding > Cardiovascular Thoracic
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools
  #1  
Old 01-06-2010, 12:37 PM
Pillow1 Pillow1 is offline
Guru
 
Join Date: Apr 2007
Location: Melbourne, Florida
Posts: 104
Pillow1 is on a distinguished road
Default Bilateral leg runoff/sfa angiogram,angioplasty and stenting

ANY HELP WOULD BE APPRECIATED IN CODING THE FOLLOWING:

PROCEDURES PERFORMED:
1. Bilateral leg runoff.
2. Left superficial femoral artery angiogram.
3. Left superficial femoral artery angioplasty.
4. Left superficial femoral artery stenting.
5. Infusion catheter placed for TPA to the distal left leg vessels.

COMPLICATIONS: Emboli to the distal left leg vessels.

WE CAME UP WITH
36200-59
75625-26
36140
75716-26-59
FOR THE BILATTERAL RUNOFF

35474 (PTA)
75962-26 (S&I)
37205 (STENT)
75960-26 (S&I)
__________________
Denise
Reply With Quote
  #2  
Old 01-06-2010, 04:15 PM
crabby1 crabby1 is offline
Contributor
 
Join Date: Apr 2007
Location: Columbus
Posts: 12
crabby1 is on a distinguished road
Default

This is how I believe this should be coded
36247- Lt SFA angiogram
75774-26
75716-26-59 - B/L lower extremity runoff
It was not indicated that an Aortogram was done so I would not use 75625
For your intervention codes
35474- SFA angioplasty
75962-26
37205- Stent
75960-26
37201 Catheter placement for TPA
75896-26
* You can only use 37201 once during the TPA treatment, however you may use 75896-26 if follow-up angiogram is done later. If a thrombectomy is done following this you should use code(s) 37184-37186.
I hope this helps.

Last edited by crabby1; 01-07-2010 at 03:59 AM. Reason: added modifer on 75716-26 and corrected code
Reply With Quote
  #3  
Old 01-07-2010, 11:14 AM
Pillow1 Pillow1 is offline
Guru
 
Join Date: Apr 2007
Location: Melbourne, Florida
Posts: 104
Pillow1 is on a distinguished road
Thumbs up

Thank you very much, I appreciate your explanation of code usage
__________________
Denise
Reply With Quote
  #4  
Old 01-08-2010, 12:00 PM
GIBBERS GIBBERS is offline
Networker
 
Join Date: Apr 2007
Location: Woodbridge, Virginia
Posts: 68
GIBBERS is on a distinguished road
Default

I agree with the above codes except for the following:

My bundling programs show that 37205 and 37201 are bundled and can not be billed together. So whenever I have coded a stent (37205/75960-26) I have not coded the transcatheter therapy (37201/75896-26)
Reply With Quote
  #5  
Old 01-13-2010, 08:11 AM
MLS2 MLS2 is offline
Expert
 
Join Date: Apr 2007
Posts: 276
MLS2 is on a distinguished road
Default

do you have an actual report for this case?
Reply With Quote
  #6  
Old 01-14-2010, 07:14 AM
Pillow1 Pillow1 is offline
Guru
 
Join Date: Apr 2007
Location: Melbourne, Florida
Posts: 104
Pillow1 is on a distinguished road
Default Bilateral leg runoff

HERE IS THE COPY OF THE 2 DAY PROCEDURE .. IT'S QUITE A BIT, THANK YOU FOR YOUR INTEREST.



DATE OF PROCEDURE: 12/30/2009

PREPROCEDURAL DIAGNOSIS: Intractable claudication with left superficial
femoral artery chronic total occlusion.

POSTPROCEDURAL DIAGNOSIS: Left superficial femoral artery chronic total
occlusion, status post stenting with subsequent thrombus embolization to the
distal vessels.

PROCEDURES PERFORMED:
1. Bilateral leg runoff.
2. Left superficial femoral artery angiogram.
3. Left superficial femoral artery angioplasty.
4. Left superficial femoral artery stenting.
5. Infusion catheter placed for TPA to the distal left leg vessels.

COMPLICATIONS: Emboli to the distal left leg vessels.

PROCEDURE DETAILS: Patient was prepped and draped in a sterile manner. A
4-French short sheath was placed into the right femoral artery. Pigtail was
placed into the aortoiliac junction. Angiogram demonstrated 100% occlusion of
the SFA at the ostium to the distal 1/3 with mild collaterals coming from the
left profunda. Subsequently a 4-French LIMA catheter was placed into the
ostium of the left iliac and a stiff-angled glidewire was advanced into the
profunda. The LIMA catheter was then advanced. The glidewire was then
exchanged out for a stiff Amplatz wire. The LIMA catheter was exchanged out,
and a 7-French Destination catheter was placed; was advanced across the horn
of the aortoiliac junction into the left iliac. Thereafter, the angled
glidewire and glide catheter were used to penetrate the chronic total
occlusion and were able to advance into the ongoing SFA and subsequently into
the popliteal.

Thereafter, a 5 x 100 peripheral balloon was advanced and ballooned 3 times
over the chronic total occlusion leaving multiple small dissections and a
significant amount of thrombus in the mid SFA. Thereafter, a 7 x 150 Cordis
Smart self-expanding stent was placed in the mid third of the SFA, covering
the thrombus. Thereafter, a 7 x 60 mm Smart Control Nitinol stent was placed
proximally to that. Thereafter, a 7 x 59 mm balloon expandable Palmaz Genesis
stent was placed from the ostium of the SFA into the proximal SFA. There were
residual 30% lesions that would have required post-stent dilatation; however,
subsequent angiogram after stenting demonstrated thrombus in the distal
vessels occluding the anterior tibialis, posterior tibialis and peroneal
vessel.

Thereafter, the LIMA catheter was placed back into the popliteal. An Amplatz
was advanced into the popliteal. The Destination catheter was exchanged out
for a short 7-French sheath. The LIMA catheter was then placed over the
Amplatz wire and the Amplatz wire was exchanged out for a long Confianza wire.
The LIMA catheter was then exchanged out for a Renegade infusion catheter
which was placed into the distal popliteal. The Confianza was then removed and
TPA was administered. During initial evaluation of the thrombus in the distal
vessels, Integrilin was hung. Patient subsequently noted improvement in his
left leg pain with TPA infusion. Patient will be admitted to the ICU for
overnight infusion of Retavase.

FINDINGS:
1. Chronic total occlusion of the SFA status post angioplasty and stenting .
2. Complication of distal embolization into the distal leg vessels involving
the anterior tibialis, posterior tibialis and the peroneal vessel.
3. Infusion catheter with Retavase for chemical thrombectomy along with
Integrilin and heparin infusions.





_________________________
, MD


Dictated by: MD





DATE OF SERVICE: 12/31/2009

PREPROCEDURE DIAGNOSES: Left distal vessel embolization and left superficial
femoral artery stenting.

POSTPROCEDURE DIAGNOSES: Distal vessel embolization with a residual mild clot
involving the mid posterior tibialis artery.

OPERATION/PROCEDURE: Superficial femoral artery angioplasty, left leg runoff
and a posterior tibialis angioplasty.

PROCEDURE PERFORMED BY: Dr. Aggarwal.

ANESTHESIA: IV Versed and fentanyl with local lidocaine.

COMPLICATIONS: None.

FINDINGS: The patient was prepped and draped in a sterile manner. The short
7-French sheath was exchanged out for a 7-French Destination using modified
Seldinger technique. Left leg runoff demonstrated patent SFA with residual
30% lesions in the prox and mid SFA and patent anterior tibialis and
superficial perioneal artery. The mid posterior tibialis was occluded but the
distal posterior tibialis was filled by collaterals from the other 2 vessels.
A Magic Torque wire was placed after a glidewire was exchanged out. A
6-French 100 mm balloon was used to inflate and post dilate the stents to a 0%
residual. Thereafter, a Confianza wire was placed into the posterior tibialis
and a 2.5 x 60 mm balloon was inflated over multiple times, using Integrelin
and heparin. There was improvement in the vessel; however, there was still
persistent clot despite extraction with a Quick-Cross and syringe suction.
There remained 100% mid posterior tibialis obstruction measuring approximately
10-15 mm in length. Nipride and nitroglycerin were injected through the
Quick-Cross into the mid posterior tibialis with no avail. However, the
patient was pain free and had distal constitution _____ collaterals.
Therefore, no further intervention was done. The patient will be placed on
Integrelin overnight.

FINDINGS: Patent saphenous vein graft stents with post-stent ballooning and
100% mid posterior tibialis with unsuccessful angioplasty.





,MD
__________________
Denise
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off




Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 03:54 PM.

AAPC - Top

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright ©2014, AAPC