Abdominal aortagraph

zizdreli

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How would you all code this? I feel like the doc is not documenting enough on cath?


Technique:
Informed written consent was obtained. A 5-French sheath was inserted in the right common femoral artery via micropuncture technique through which right lower extremity angiography was performed. Aortography was performed via a 5-French contra flush catheter. Left lower extremity angiography was performed via a 5 French contra-2 catheter. The contra 2 catheter and 5 French sheath were removed over an 035 wire and a Perclose device was deployed in the right common femoral artery with good hemostasis. There were no complications.


Results:
Abdominal aortography: The infrarenal abdominal aorta is notable for mild dilatation distally but otherwise free of significant disease. The right common iliac artery is notable for 30% proximal stenosis without pressure gradient. The left common iliac artery is widely patent.

Right lower extremity angiography: The external and internal iliac arteries are patent. The common femoral artery is notable for mild plaque but otherwise widely patent. The profundofemoral and superficial femoral arteries are widely patent. The popliteal artery, anterior tibial, posterior tibial and peroneal arteries are patent without significant disease.

Left lower extremity angiography: The external and internal iliac arteries are patent. The common femoral artery is chronically occluded distally as is the proximal superficial femoral artery. There is reconstitution of the profundofemoral and proximal SFA via well-developed collaterals. The SFA is otherwise widely patent. The popliteal artery is widely patent. The anterior tibial, posterior tibial and peroneal arteries are patent to the foot.


Summary and Conclusions:
1. Chronic total occlusion distal left common femoral artery/proximal left superficial femoral artery.
2. Successful Perclose right common femoral artery.


Plan:
Vascular surgery consultation will be obtained for left common femoral endarterectomy.
 

Jim Pawloski

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I would code this 36245-LT and 75716. And yes, there is really not enough information. I like where I am told a story of what was done. Basically, where is the puncture site, where did the catheter go, and what did you look at and find.

HTH,
Jim Pawloski, CIRCC, R.T. (CV)
 
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I would not give more than 36200 on this one. It's possible to do the contralateral imaging with the cath in the aorta. For imaging 75716. Would like to see more detail on the abdominal aortogram to know if a complete study was actually performed. You definitely need better documentation all the way around.
 

dpeoples

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non- selective is all that is documented, non-selective is all you should code, 36140. I know it is not possible to see the left extremity with non selective cath placement in the right extremity, but he/she does not document catheter end position.
Send it back to the physician if you can.
 
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