Pop angioplasty unsuccesful
Please help me to code this report, my physician has attempted angioplasty it was unsucccesful so i havent coded it.But he is telling that he tried for 2 hours he need it to be coded (can i code it or not)
Informed consent was obtained. The patient was prepped and draped
appropriately and after infiltration with local anesthesia, the
right common femoral artery was punctured with a 19 gauge needle
and a Newton J. wire advanced into the abdominal aorta where an
exchange was made for a 4 French omni flush through which
contrast was injected. The catheter was then manipulated around
the bifurcation to the left external iliac artery where injections
were performed with filming down the left leg. The catheter was
then pulled back to the right external iliac artery and further
injections performed with filming down the right leg.
There is minimal atherosclerotic disease and no significant
stenoses are seen.
There is moderate calcification in the superficial femoral and
popliteal arteries. The superficial femoral artery is patent in
continuity with the popliteal artery but there is a significant
stenosis in the proximal popliteal artery associated with
significant calcification. There is the origin of three vessel
runoff but the posterior tibial artery includes in the mid calf.
There is extensive calcification in the anterior tibial artery
which occludes and then reconstitutes 5 cm from its origin. The
main runoff is through the peroneal artery.
The superficial femoral artery is patent in continuity with the
popliteal artery and extensive calcification is seen throughout.
In the proximal popliteal artery there is a subtotal occlusion
associated with a densely calcified eccentric plaque. There is
two vessel runoff via the peroneal and posterior tibial arteries.
The posterior tibial artery crosses the ankle to supply the
posterior portion of the foot. The dorsalis pedis does not
Right popliteal artery angioplasty.
The previously placed catheter was removed and compression applied
for 10 minutes. An antegrade puncture was then performed on the
right side with a micropuncture set and a five French sheath
introduced. Through this a five French angioplasty catheter was
passed down to just above the lesion and the subtotal occlusion
roadmapped. 2000 units of heparin were given intravenously.
Multiple attempts were made to pass around the obstruction
without success. Multiple attempts with a Rosen wire leading were
also unsuccessful. Ultimately, the stiff Terumo went subintimally
but could not be guided back into the lumen. The angioplasty was
abandoned and contrast injection demonstrated a short segment
occlusion with no change in the runoff. Compression was applied
for 10 minutes after removing the sheath..
Right popliteal artery subtotal occlusion with a failed attempt
at angioplasty. There is a similar but less severe lesion on the
per the Interventional Radiology Coding Users' Guide 2008
"If an angioplasty of an occlusion is unsuccessful because the lesion cannot be crossed, then the appropriate access/and or selection only should be coded. On the other hand, if the lesion is crossed and the angioplasty is performed but with an unacceptable outcome, then the angioplasty is coded since all the work of the angioplasty was done."