Failed attempt to cannulate left SFA?

[aeberle2]

Procedure performed:
1. Cannulation of the right common femoral artery.
2. Second order catheter placement in the left common femoral artery from the right side.
3. Attempt to cannulate an occluded left superficial femoral artery unsuccessfully.

Indications:
PVD, claudication. The pt was here last week. We attempted to cross the left SFA with traditional wires and catheters. However it was not successful. This time, we will bring him back to try a crosser device.

Description of Procedure:
After obtaining informed consent, the patient was brought into the cath lab. He was prepped and draped to obtain a sterile field. The right groin was anesthetized with 1% lidocaine. The right common femoral artery was cannulated using modified Seldinger technique with 5-French sheath. Them a RIM catheter was used to cannulate the left common iliac artery. At this point, a Terumo wire was placed distally in the left profunda femoris artery. The RIM catheter was advanced. The Terumo wire was removed. The Supracore wire was placed in the distal left profunda femoris. Then, the RIM catheter and the 5-French sheath were removed. At this point, a 7-French Raabe sheath was placed over the Supracore wire just above the level of the left common femoral artery. Then, the Supracore wire was removed. 5000 units of intravenous heparin were given. An attempt to cannulate the occluded left SFA using the crosser device failed after multiple trials. At this point, we decided to stop. The Raabe sheath was removed, exchanged into a short 7-French sheath, and an Angio-seal device was deployed. The patient tolerated well the procedure. There were no complications. He left the catheterization laboratory hemodynamically stable and neurologically intact.

Impression:
In conclusion, attempt to cannulate an occluded left SFA was unsuccessful. At this point, I would recommend medical therapy in terms of a walking program.

Can anyone tell me what, if anything, is billable for this unsuccessful procedure and how to code it? The only thing a can pick out is catheter placement into the left common femoral artery, but I am not sure if you can bill for catheter placement only. Thoughts?

[theresa.dix@ethc.com]

Originally Posted by aeberle2

Procedure performed:
1. Cannulation of the right common femoral artery.
2. Second order catheter placement in the left common femoral artery from the right side.
3. Attempt to cannulate an occluded left superficial femoral artery unsuccessfully.

Indications:
PVD, claudication. The pt was here last week. We attempted to cross the left SFA with traditional wires and catheters. However it was not successful. This time, we will bring him back to try a crosser device.

Description of Procedure:
After obtaining informed consent, the patient was brought into the cath lab. He was prepped and draped to obtain a sterile field. The right groin was anesthetized with 1% lidocaine. The right common femoral artery was cannulated using modified Seldinger technique with 5-French sheath. Them a RIM catheter was used to cannulate the left common iliac artery. At this point, a Terumo wire was placed distally in the left profunda femoris artery. The RIM catheter was advanced. The Terumo wire was removed. The Supracore wire was placed in the distal left profunda femoris. Then, the RIM catheter and the 5-French sheath were removed. At this point, a 7-French Raabe sheath was placed over the Supracore wire just above the level of the left common femoral artery. Then, the Supracore wire was removed. 5000 units of intravenous heparin were given. An attempt to cannulate the occluded left SFA using the crosser device failed after multiple trials. At this point, we decided to stop. The Raabe sheath was removed, exchanged into a short 7-French sheath, and an Angio-seal device was deployed. The patient tolerated well the procedure. There were no complications. He left the catheterization laboratory hemodynamically stable and neurologically intact.

Impression:
In conclusion, attempt to cannulate an occluded left SFA was unsuccessful. At this point, I would recommend medical therapy in terms of a walking program.

Can anyone tell me what, if anything, is billable for this unsuccessful procedure and how to code it? The only thing a can pick out is catheter placement into the left common femoral artery, but I am not sure if you can bill for catheter placement only. Thoughts?

Well this is confusing that is for sure. You really have to study it to pick anything out. Back and forth with sheath and cath placement and removal!

What I see here is the most you can code is a cath placement to the left common Iliac from the right femoral artery. 36245. They entered the right femoral crossed over to the left commn Iliac. At this point a wire was place in the profunda and the rim catheter was advanced, but where was it advanced to? I wouldnt code that part since it doesnt actually tell us where it was advanced. So yes you can code cath placement only.

Does anyone else see anything different? Its early morning and I might not be seeing things right!