Procedure in detail: Need help, please!
Patient brought to cath lab, sheath was inserted in RCFA, then pigtail cath was positioned in Ascending Aortic arch, just above root and thoracic aortic arch aortogram was performed, on low magn ification so that entire descending aorta was visualized. Following this, pigtail cath was positioned in AA, above origins of renal arteries and superior mesenteric artery. An AA was performed. Following this selective cannulation was performed in LRA. It demonstrated 90% stenosis in proximal portion of LRA. Multiple attemps were made to engage RRA, but was unable to do so. Patients aorta was friable, consistent w/some form of aortitis and/or atherosclerotic disease. Could not torque the cath into RRA because cath kept picking up debris and atherosclerotic plaques. Because of this doc didnt want to be more agressive w/trying to engage right renal ostium and stop trying. At end of case, pigtail cath was positioned with side holes at level of renal arteries and an RAO projections was obtained. An AA was then performed w/30cc of contrast, which showed normal flow into RRA and mild irregularites through out, but no evidence of high grade stenosis in RRA. The decision was made to proceed to PTA and stent of LRA.A SV* wire was used to cross the lesion, but this proved to be too stiff to advance and this wire was exchanged for a balance middleweight wire. A slalom ballon was used to dilate the lesion and size the stent. Following this, a 6 mm x18 stent was positioned at target site and it was deployed to optimal pressure. The balloon was then hung out into the aorta and ostium was burnished to insure that it was well opposed. Final angiography revealed excellent result, with complete coverage of lesion and no dissection or complications noted.
Final Assessment: Successful PTA and stentinog of Left renal artery, Right renal artery demonstrates diffuse irregularities and calcification at the origin, but no significant stenosis detected.
What codes to use: 35471, 75966 36245 or 36252, 75605, 75625.... help please
Patient brought to cath lab, sheath was inserted in RCFA, then pigtail cath was positioned in Ascending Aortic arch, just above root and thoracic aortic arch aortogram was performed, on low magn ification so that entire descending aorta was visualized. Following this, pigtail cath was positioned in AA, above origins of renal arteries and superior mesenteric artery. An AA was performed. Following this selective cannulation was performed in LRA. It demonstrated 90% stenosis in proximal portion of LRA. Multiple attemps were made to engage RRA, but was unable to do so. Patients aorta was friable, consistent w/some form of aortitis and/or atherosclerotic disease. Could not torque the cath into RRA because cath kept picking up debris and atherosclerotic plaques. Because of this doc didnt want to be more agressive w/trying to engage right renal ostium and stop trying. At end of case, pigtail cath was positioned with side holes at level of renal arteries and an RAO projections was obtained. An AA was then performed w/30cc of contrast, which showed normal flow into RRA and mild irregularites through out, but no evidence of high grade stenosis in RRA. The decision was made to proceed to PTA and stent of LRA.A SV* wire was used to cross the lesion, but this proved to be too stiff to advance and this wire was exchanged for a balance middleweight wire. A slalom ballon was used to dilate the lesion and size the stent. Following this, a 6 mm x18 stent was positioned at target site and it was deployed to optimal pressure. The balloon was then hung out into the aorta and ostium was burnished to insure that it was well opposed. Final angiography revealed excellent result, with complete coverage of lesion and no dissection or complications noted.
Final Assessment: Successful PTA and stentinog of Left renal artery, Right renal artery demonstrates diffuse irregularities and calcification at the origin, but no significant stenosis detected.
What codes to use: 35471, 75966 36245 or 36252, 75605, 75625.... help please
