richmorris10
Guest
Help!!
I'm a little confused as to how to code this? 75625 with 75710? Cath placement as 36246?
PREOPERATIVE DIAGNOSIS: Ischemic right lower extremity.
POSTOPERATIVE DIAGNOSIS: Ischemic right lower extremity.
PROCEDURE:
1. Ultrasound guided access to left common femoral artery using
micropuncture technique.
2. Abdominal aortogram.
3. Select catheterization of the right common femoral artery with
right lower extremity angiogram.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
SPECIMEN: None.
ANESTHESIA: 1 mg of Versed, 50 mcg of fentanyl for a total sedation
time of 38 minutes.
PROCEDURE IN DETAIL: The patient was brought to the specials suite
where informed consent was obtained. Surgical pause was performed.
Under ultrasound guidance and micropuncture technique, the left common
femoral artery was accessed and upsized to a 5-French sheath.
Sedation was administered along with lidocaine during the case that
was a total sedation time of 38 minutes and that was 1 mg of Versed
and 50 mcg of fentanyl. An aortogram was then performed which
revealed a widely patent celiac, SMA, bilateral renal arteries. The
infrarenal aorta was also widely patent, free of any type of stenosis.
Bilateral common and external iliac arteries were also widely patent.
Right common femoral artery was then selectively catheterized and a
right lower extremity angiogram performed. This revealed an abrupt
occlusion of the SFA right at the common femoral artery origin.
Profunda was the main blood supply to the lower leg. The SFA is out
in its entirety as well as the previous bypass graft. A wire could
not be easily advanced into the old cadaver bypass graft. Based on my
suspicion of clinical exam, this has likely been down at least 2-3
weeks. The AK popliteal and BK popliteal arteries were all occluded
with multiple collateral flows off the distal profunda into the lower
extremity. The posterior tibial artery was only primary blood flow
into the foot. This is a small diminutive with very little flow. In
addition, at this point in time there is necrotic area over this
distal portion of the PT where it reconstitutes. Based on these
findings, there was really no further intervention possible and the
patient will likely require below-knee amputation. I was present for
the entire procedure and all sponge and needle counts were correct.
I'm a little confused as to how to code this? 75625 with 75710? Cath placement as 36246?
PREOPERATIVE DIAGNOSIS: Ischemic right lower extremity.
POSTOPERATIVE DIAGNOSIS: Ischemic right lower extremity.
PROCEDURE:
1. Ultrasound guided access to left common femoral artery using
micropuncture technique.
2. Abdominal aortogram.
3. Select catheterization of the right common femoral artery with
right lower extremity angiogram.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
SPECIMEN: None.
ANESTHESIA: 1 mg of Versed, 50 mcg of fentanyl for a total sedation
time of 38 minutes.
PROCEDURE IN DETAIL: The patient was brought to the specials suite
where informed consent was obtained. Surgical pause was performed.
Under ultrasound guidance and micropuncture technique, the left common
femoral artery was accessed and upsized to a 5-French sheath.
Sedation was administered along with lidocaine during the case that
was a total sedation time of 38 minutes and that was 1 mg of Versed
and 50 mcg of fentanyl. An aortogram was then performed which
revealed a widely patent celiac, SMA, bilateral renal arteries. The
infrarenal aorta was also widely patent, free of any type of stenosis.
Bilateral common and external iliac arteries were also widely patent.
Right common femoral artery was then selectively catheterized and a
right lower extremity angiogram performed. This revealed an abrupt
occlusion of the SFA right at the common femoral artery origin.
Profunda was the main blood supply to the lower leg. The SFA is out
in its entirety as well as the previous bypass graft. A wire could
not be easily advanced into the old cadaver bypass graft. Based on my
suspicion of clinical exam, this has likely been down at least 2-3
weeks. The AK popliteal and BK popliteal arteries were all occluded
with multiple collateral flows off the distal profunda into the lower
extremity. The posterior tibial artery was only primary blood flow
into the foot. This is a small diminutive with very little flow. In
addition, at this point in time there is necrotic area over this
distal portion of the PT where it reconstitutes. Based on these
findings, there was really no further intervention possible and the
patient will likely require below-knee amputation. I was present for
the entire procedure and all sponge and needle counts were correct.