75625 vs 75630 please help

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Procedure list in detail:
1. Aortogram
2. Bilateral lower extremity arteriogram
3. Second order selective catheterization of the left common femoral artery from right femoral approach
4. Stent angioplasty of the infrarenal aorta with 12 mm x 30 mm epic self-expanding stent postdilated with 9 mm balloon
5. Ultrasound-guided puncture of the right common femoral artery
6. Radiologic supervision interpretation of above

Post-operative Diagnosis: Post-op Diagnosis
* Atherosclerosis of native artery of left lower extremity with rest pain (CMS/HCC) [I70.222]

Indications: Critical ischemia of the left lower extremity

Implants:
Implant Name Type Inv. Item Serial No. Manufacturer Lot No. LRB No. Used Action
135034_STENT VASCULAR 30MM 12MM EPIC 75CM ILIAC ARTERY NITINOL SELF EXPAND 109CM ACCEPTS 6FR SHEATH - LOG353919 Implant 135034_STENT VASCULAR 30MM 12MM EPIC 75CM ILIAC ARTERY NITINOL SELF EXPAND 109CM ACCEPTS 6FR SHEATH Boston Scientific 22623219 N/A 1 Implanted

Description of the procedure:
Following informed consent and timeout protocol the femoral areas were prepped and draped using Chloraprep.

Lidocaine 1% was infiltrated at the puncture under ultrasound guidance.Ultrasound was used to evaluate potential access sites for patency. The target vessel was then accessed under real time ultrasound guidance verifying intravascular needle entry. Images are stored in the chartThe right femoral artery(ies) accessed using micropuncture technique under realtime ultrasound image guidance. Image with needle in the femoral artery was submitted for documentation into the patient's record.Femoral sheath was placed without difficulty.

Aortic catheterization was performed. Selective catheterization was performed as necessary for optimal visualization and contrast dose reduction.Images were obtained with digital subtraction and/or cine mode following intra-arterial contrast injection. Second order selective catheterization was performed of the left common femoral artery from the right femoral approach with a UF catheter.

Following completion of the arteriogram and endovascular interventions the sheath(s) removed and closure device deployed. Hemostasis was insured prior to transfer to the PACU.

Angiographic findings in detail:
The aorta is patent. There is irregular plaque in the infrarenal aorta with a mid segment at least moderate stenosis from eccentric plaque. The bilateral renal arteries are patent with moderate stenosis of the right renal artery and mild stenosis of the left renal artery. The mesenteric branches fill from the AP projection.

The left common iliac artery is patent with mild proximal stenosis. Left external iliac is widely patent. The left internal iliac is patent with small. The right common iliac is mildly stenotic proximally. The right internal iliac artery is patent. The right external iliac artery is patent.

The left common femoral artery is patent without significant stenosis. The left deep femoral artery is patent without significant stenosis. Proximal and mid SFA has previously been stented. The entire stented segment is severely stenotic and essentially functionally occluded. Collaterals reconstitute the distal SFA and above-knee popliteal artery. There is single-vessel peroneal runoff with the anterior tibial artery occluded proximally ending in collaterals. Posterior tibial artery is not visualized. There is disease at the plantar level with the peroneal artery collateralizing a single plantar branch and a very diseased dorsal arch.

The right common femoral and deep femoral arteries are patent. The right superficial femoral artery is patent and is been stented in 2 sites. The mid segment stent is stenotic at its origin. The distal stent is stenotic in its midportion and at its termination. The popliteal artery is patent. The anterior tibial and posterior tibial arteries are occluded. The peroneal artery is patent but significantly diseased in its distal third providing collateral flow to diseased plantar branches. Dorsal circulation of the right foot does not opacify.

Description of endovascular interventions:
Due to multiple recurrence of the left SFA stenosis I felt further endovascular intervention was not likely to be successful at this point. With the finding of the aortic stenosis I elected to treat it endovascular and hoping to improve her inflow sufficiently to alleviate some of her chronic ischemic symptoms.

The aortic lesion was crossed without difficulty and a 6 French destination sheath positioned across it. A 12 mm x 30 mm epic stent was then positioned across the lesion and sheath withdrawn. Stent was deployed and postdilated with a 9 mm balloon. There did not appear to be any significant residual stenosis dissection or extravasation.
Summary of findings:
1. Infrarenal aortic stenosis successfully treated with stent angioplasty
2. Aggressive recurrence of stenosis within the left stented segment of the SFA near functional occlusion
3. Severe tibial and small vessel disease of the left lower extremity with peroneal runoff
4. Right SFA with 2 areas of significant stenosis and previously stented segments and heavily diseased single-vessel peroneal runoff to the right foot
5. Severe small vessel disease in the right foot


I am now questioning myself if I have been using 75625 & 7563 correctly.
please help
37236
36246
75625 26 or 75630 26
75716 26
76937 26
 

suchang78

Guru
Messages
127
Location
Baldwin Park, CA
Best answers
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Procedure list in detail:
1. Aortogram
2. Bilateral lower extremity arteriogram
3. Second order selective catheterization of the left common femoral artery from right femoral approach
4. Stent angioplasty of the infrarenal aorta with 12 mm x 30 mm epic self-expanding stent postdilated with 9 mm balloon
5. Ultrasound-guided puncture of the right common femoral artery
6. Radiologic supervision interpretation of above

Post-operative Diagnosis: Post-op Diagnosis
* Atherosclerosis of native artery of left lower extremity with rest pain (CMS/HCC) [I70.222]

Indications: Critical ischemia of the left lower extremity

Implants:
Implant Name Type Inv. Item Serial No. Manufacturer Lot No. LRB No. Used Action
135034_STENT VASCULAR 30MM 12MM EPIC 75CM ILIAC ARTERY NITINOL SELF EXPAND 109CM ACCEPTS 6FR SHEATH - LOG353919 Implant 135034_STENT VASCULAR 30MM 12MM EPIC 75CM ILIAC ARTERY NITINOL SELF EXPAND 109CM ACCEPTS 6FR SHEATH Boston Scientific 22623219 N/A 1 Implanted

Description of the procedure:
Following informed consent and timeout protocol the femoral areas were prepped and draped using Chloraprep.

Lidocaine 1% was infiltrated at the puncture under ultrasound guidance.Ultrasound was used to evaluate potential access sites for patency. The target vessel was then accessed under real time ultrasound guidance verifying intravascular needle entry. Images are stored in the chartThe right femoral artery(ies) accessed using micropuncture technique under realtime ultrasound image guidance. Image with needle in the femoral artery was submitted for documentation into the patient's record.Femoral sheath was placed without difficulty.

Aortic catheterization was performed. Selective catheterization was performed as necessary for optimal visualization and contrast dose reduction.Images were obtained with digital subtraction and/or cine mode following intra-arterial contrast injection. Second order selective catheterization was performed of the left common femoral artery from the right femoral approach with a UF catheter.

Following completion of the arteriogram and endovascular interventions the sheath(s) removed and closure device deployed. Hemostasis was insured prior to transfer to the PACU.

Angiographic findings in detail:
The aorta is patent. There is irregular plaque in the infrarenal aorta with a mid segment at least moderate stenosis from eccentric plaque. The bilateral renal arteries are patent with moderate stenosis of the right renal artery and mild stenosis of the left renal artery. The mesenteric branches fill from the AP projection.

The left common iliac artery is patent with mild proximal stenosis. Left external iliac is widely patent. The left internal iliac is patent with small. The right common iliac is mildly stenotic proximally. The right internal iliac artery is patent. The right external iliac artery is patent.

The left common femoral artery is patent without significant stenosis. The left deep femoral artery is patent without significant stenosis. Proximal and mid SFA has previously been stented. The entire stented segment is severely stenotic and essentially functionally occluded. Collaterals reconstitute the distal SFA and above-knee popliteal artery. There is single-vessel peroneal runoff with the anterior tibial artery occluded proximally ending in collaterals. Posterior tibial artery is not visualized. There is disease at the plantar level with the peroneal artery collateralizing a single plantar branch and a very diseased dorsal arch.

The right common femoral and deep femoral arteries are patent. The right superficial femoral artery is patent and is been stented in 2 sites. The mid segment stent is stenotic at its origin. The distal stent is stenotic in its midportion and at its termination. The popliteal artery is patent. The anterior tibial and posterior tibial arteries are occluded. The peroneal artery is patent but significantly diseased in its distal third providing collateral flow to diseased plantar branches. Dorsal circulation of the right foot does not opacify.

Description of endovascular interventions:
Due to multiple recurrence of the left SFA stenosis I felt further endovascular intervention was not likely to be successful at this point. With the finding of the aortic stenosis I elected to treat it endovascular and hoping to improve her inflow sufficiently to alleviate some of her chronic ischemic symptoms.

The aortic lesion was crossed without difficulty and a 6 French destination sheath positioned across it. A 12 mm x 30 mm epic stent was then positioned across the lesion and sheath withdrawn. Stent was deployed and postdilated with a 9 mm balloon. There did not appear to be any significant residual stenosis dissection or extravasation.
Summary of findings:
1. Infrarenal aortic stenosis successfully treated with stent angioplasty
2. Aggressive recurrence of stenosis within the left stented segment of the SFA near functional occlusion
3. Severe tibial and small vessel disease of the left lower extremity with peroneal runoff
4. Right SFA with 2 areas of significant stenosis and previously stented segments and heavily diseased single-vessel peroneal runoff to the right foot
5. Severe small vessel disease in the right foot


I am now questioning myself if I have been using 75625 & 7563 correctly.
please help
37236
36246
75625 26 or 75630 26
75716 26
76937 26

I will code 75630, one catheter placement in aorta.
 

Jim Pawloski

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Ann Arbor
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I disagree with Suchang78. I would code 75625 for the abdominal aortogram, since the renals are described. I would use 75630 if the aortogram was used for a pre-op arteriogram for AAA stent ( not done anymore as CTA is usually done for AAA stent graft) or if there is no movement of the catheter from the upper abdominal aorta to the lower aorta. The rest of your codes I agree with.

HTH,
Jim Pawloski, CIRCC
 

suchang78

Guru
Messages
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Location
Baldwin Park, CA
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I disagree with Suchang78. I would code 75625 for the abdominal aortogram, since the renals are described. I would use 75630 if the aortogram was used for a pre-op arteriogram for AAA stent ( not done anymore as CTA is usually done for AAA stent graft) or if there is no movement of the catheter from the upper abdominal aorta to the lower aorta. The rest of your codes I agree with.

HTH,
Jim Pawloski, CIRCC
I thought 75625 requires 2 catheter placements to be coded. 75630- with limit renal finding, and ideally with SMA, IMA, and celiac arteries finding. I picked 75630 because I only see one catheter placement in this case with bilateral run-off.
 

Jim Pawloski

True Blue
Messages
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Location
Ann Arbor
Best answers
0
This is what was posted -
Second order selective catheterization was performed of the left common femoral artery from the right femoral approach with a UF catheter.
So there is your catheter movement.
 
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