suela923@aol.com
Guest
- Messages
- 178
- Best answers
- 0
Would you bill 37236, 37236-59 because one is on the left side and the other on the right? Or would you bill 37236, 37237 because the initial artery stented was the left subclavian and the additional artery stented was the innominate. The CPT book doesn't state that it has to be isipilateral.
Thanks!
Procedure: Thoracic aortic arch angiogram. Stent placement of the left subclavian artery and innominate artery stenoses.
Indication: Severe occlusive disease of the great vessels.
Results: Patient was identified and brought to the vascular unit. The right groin was prepped and draped in the usual sterile fashion. 2% lidocaine was used to infiltrate the skin over the right femoral artery. An angiographic needle, wire, and 5-French sheath were then placed. A flush catheter was placed at the level of the aortic arch. Flush angiography was performed with the following findings. The aortic arch is patent. There is a moderate to severe stenoses at the origin of the innominate artery. The right subclavian and common carotid arteries are patent without stenoses. The left common carotid artery is occluded. There is a moderate to severe stenoses at the mid segment of the left subclavian artery. The right vertebral artery appears to be patent. The left vertebral artery is patent as well.
No prior angiographic study is available for review. A complete diagnostic study is performed. Decision to intervene was based on the current diagnostic study.
Patient was systemically heparinized with weight based bolus dose heparin 100 units per kilogram. The 5-French sheath was then exchanged for a 7-French 90 cm shuttle sheath. The left subclavian artery was selected with a Berenstein catheter and an angled Glidewire was utilized to traverse the stenotic segment in the subclavian artery. Wire exchange was performed with a 300 CM stork wire. The lesion in the proximal aspect of the left subclavian artery was then treated primarily with stent placement. An 8mm x 29 mm Genesis stent was placed without difficulty. Completion study showed patency of the stented segment with excellent flow through the subclavian artery, vertebral artery, and internal mammary artery. The wire was then removed and using a selective catheter the innominate artery was selected. The 300 CM stork wire was placed through to the right subclavian artery to facilitate innominate artery stent placement. The innominate artery lesion was primarily treated with a 10 mm x 29 mm balloon expandable stent. The proximal portion of the stent was then dilated to 12 mm with an angioplasty balloon. Excellent result was obtained. Completion study showed patency of the stented segment without residual stenoses. At the completion of the case, the heparin was reversed with protamine. Once the ACT was less than 200 the sheath was removed and pressure was held without incident. Patient tolerated the procedure well and left in stable condition.
Result Impression
Moderate to severe stenoses at the origin of the innominate artery and left subclavian artery, primarily treated with stent placement with good result. Occluded left common carotid artery
Thanks!
Procedure: Thoracic aortic arch angiogram. Stent placement of the left subclavian artery and innominate artery stenoses.
Indication: Severe occlusive disease of the great vessels.
Results: Patient was identified and brought to the vascular unit. The right groin was prepped and draped in the usual sterile fashion. 2% lidocaine was used to infiltrate the skin over the right femoral artery. An angiographic needle, wire, and 5-French sheath were then placed. A flush catheter was placed at the level of the aortic arch. Flush angiography was performed with the following findings. The aortic arch is patent. There is a moderate to severe stenoses at the origin of the innominate artery. The right subclavian and common carotid arteries are patent without stenoses. The left common carotid artery is occluded. There is a moderate to severe stenoses at the mid segment of the left subclavian artery. The right vertebral artery appears to be patent. The left vertebral artery is patent as well.
No prior angiographic study is available for review. A complete diagnostic study is performed. Decision to intervene was based on the current diagnostic study.
Patient was systemically heparinized with weight based bolus dose heparin 100 units per kilogram. The 5-French sheath was then exchanged for a 7-French 90 cm shuttle sheath. The left subclavian artery was selected with a Berenstein catheter and an angled Glidewire was utilized to traverse the stenotic segment in the subclavian artery. Wire exchange was performed with a 300 CM stork wire. The lesion in the proximal aspect of the left subclavian artery was then treated primarily with stent placement. An 8mm x 29 mm Genesis stent was placed without difficulty. Completion study showed patency of the stented segment with excellent flow through the subclavian artery, vertebral artery, and internal mammary artery. The wire was then removed and using a selective catheter the innominate artery was selected. The 300 CM stork wire was placed through to the right subclavian artery to facilitate innominate artery stent placement. The innominate artery lesion was primarily treated with a 10 mm x 29 mm balloon expandable stent. The proximal portion of the stent was then dilated to 12 mm with an angioplasty balloon. Excellent result was obtained. Completion study showed patency of the stented segment without residual stenoses. At the completion of the case, the heparin was reversed with protamine. Once the ACT was less than 200 the sheath was removed and pressure was held without incident. Patient tolerated the procedure well and left in stable condition.
Result Impression
Moderate to severe stenoses at the origin of the innominate artery and left subclavian artery, primarily treated with stent placement with good result. Occluded left common carotid artery