SCHAUFLER
New
Would someone be able to help me with this discrepency I am having. The providers I am currently working with are really confusing me. Please see operative note below how would you code this? These are the codes for this procedure that they have chosen:
Diagnostic abdominal aortogram 75625
Diagnositic bilateral lower extremity arteriogram 75716
Bilateral common femoral artery access: 36200-50
Bilateral iliac artery angioplasty with stenting 37221-50
Left external iliac artery angioplasty and stenting ipsilateral 37223
I disagree with 36200-50 for sure.
Once completed with the left femoral endarterectomy, thrombectomy and patch angioplasty the right common femoral artery was accessed under ultrasound guidance and a micropuncture system. A Glidewire advantage wire was advanced into the abdominal aorta and initially a 5 French sheath was placed. A UF catheter was advanced over the wire into the abdominal aorta. An abdominal aortogram was performed which demonstrated the left common and external iliac artery occlusion. The aortic bifurcation was crossed and I was able to advance the wire into the profunda femoris. The catheter was then advanced to the level of the common femoral artery and additional imaging of the left iliac system was obtained. It appeared that there was thrombus and chronic plaque present most predominantly in the common iliac artery. The left common femoral artery patch was then accessed utilizing a micropuncture system and a 7 French sheath was placed. A 7 mm x 59 mm VBX stent was deployed at the origin of the left common iliac artery. A second VBX stent measuring 7 mm x 59 mm was then deployed to cover the external iliac artery. Completion imaging demonstrated marked improvement but there was what appeared to be residual mobile thrombus at the origin of the left common iliac artery. I then decided to elevate the bifurcation. The right common femoral artery sheath was upsized to a 7 French sheath. A 7 mm x 39 mm VBX stent was placed in the right common iliac artery and an 8 mm x 39 mm VBX stent was placed in the left common iliac artery. The stents were deployed simultaneously covering the mobile thrombus and slightly elevating the bifurcation. Completion imaging demonstrated marked improvement in brisk flow. Of note during the manipulation and treatment of the left iliac artery the profunda femoris outflow was occluded to avoid any distal thrombotic emboli.
A left lower extremity arteriogram was then performed which demonstrated the chronic left SFA occlusion with reconstitution of the above-knee popliteal artery. The mid and distal popliteal artery appeared patent with three-vessel tibial artery runoff distally. The anterior tibial artery was dominant to the foot post procedure a Doppler signal was present.
Imaging was then obtained through the right common femoral artery sheath and a mynx closure device was used for closure. A sterile dressing was applied the left common femoral artery patch arteriotomy was closed in an open fashion.
Diagnostic abdominal aortogram 75625
Diagnositic bilateral lower extremity arteriogram 75716
Bilateral common femoral artery access: 36200-50
Bilateral iliac artery angioplasty with stenting 37221-50
Left external iliac artery angioplasty and stenting ipsilateral 37223
I disagree with 36200-50 for sure.
Once completed with the left femoral endarterectomy, thrombectomy and patch angioplasty the right common femoral artery was accessed under ultrasound guidance and a micropuncture system. A Glidewire advantage wire was advanced into the abdominal aorta and initially a 5 French sheath was placed. A UF catheter was advanced over the wire into the abdominal aorta. An abdominal aortogram was performed which demonstrated the left common and external iliac artery occlusion. The aortic bifurcation was crossed and I was able to advance the wire into the profunda femoris. The catheter was then advanced to the level of the common femoral artery and additional imaging of the left iliac system was obtained. It appeared that there was thrombus and chronic plaque present most predominantly in the common iliac artery. The left common femoral artery patch was then accessed utilizing a micropuncture system and a 7 French sheath was placed. A 7 mm x 59 mm VBX stent was deployed at the origin of the left common iliac artery. A second VBX stent measuring 7 mm x 59 mm was then deployed to cover the external iliac artery. Completion imaging demonstrated marked improvement but there was what appeared to be residual mobile thrombus at the origin of the left common iliac artery. I then decided to elevate the bifurcation. The right common femoral artery sheath was upsized to a 7 French sheath. A 7 mm x 39 mm VBX stent was placed in the right common iliac artery and an 8 mm x 39 mm VBX stent was placed in the left common iliac artery. The stents were deployed simultaneously covering the mobile thrombus and slightly elevating the bifurcation. Completion imaging demonstrated marked improvement in brisk flow. Of note during the manipulation and treatment of the left iliac artery the profunda femoris outflow was occluded to avoid any distal thrombotic emboli.
A left lower extremity arteriogram was then performed which demonstrated the chronic left SFA occlusion with reconstitution of the above-knee popliteal artery. The mid and distal popliteal artery appeared patent with three-vessel tibial artery runoff distally. The anterior tibial artery was dominant to the foot post procedure a Doppler signal was present.
Imaging was then obtained through the right common femoral artery sheath and a mynx closure device was used for closure. A sterile dressing was applied the left common femoral artery patch arteriotomy was closed in an open fashion.