Angiogram - Carotid - Pls review our codes - We are all new to IR

dkhclement

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La Place, LA
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Pls see our codes at the end of the procedure report. We are all new to IR and would love another opinion.

Angiogram Procedure Note

Pre-Operative Diagnosis:
1. Peripheral Artery Disease with disabling claudication
2. Left carotid occlusion
3. Right carotid stenosis, severe

Post-Operative Diagnosis: Same, aortic occlusive disease

Procedure:
1. Left common femoral artery access under ultrasound guidance
2. Left radial artery access under ultrasound guide
3. Arch aortogram
4. Right carotid and subclavian artery angiogram
5. Abdominal aortogram with lateral views

Anesthesia Type: Moderate sedation

Procedure Details:
After informed was obtained patient was taken to the cath lab. Placed in the supine position. Bilateral groins and left arm was prepped in the usual sterile fashion. We began by accessing the left common artery under ultrasound guidance. We advanced the micro sheath was over the wire and then placed a 5 French sheath in the left common femoral artery. We then advanced the soft angled Glidewire over a glide cath but there was noted to be a flush occlusion near without the left external iliac artery was located. We tried to get across with this occlusion but after multiple attempts failed. We then decided to get access in the left brachial artery under ultrasound guidance. We advanced a slender 4 French sheath over the wire and then I soft angled glide wire into the arch aortic arch. We heparinized the patient at this point and obtained ACTs. We then advanced a angled pigtail into the aorta aorta ascending aorta and performed arch aortogram see findings. We then selected right subclavian artery with a soft vu catheter and performed a angiogram see findings. We then used the same catheter in selected the right common carotid artery and then performed a angiogram. At that point we then withdrew our catheter and advanced our soft angled Glidewire into the descending thoracic aorta down to the abdominal aorta and then advanced a pigtail catheter over the wire performed an abdominal aortogram. See findings. We then took lateral shots. See findings. We then advanced the pigtail into the infrarenal aorta before the bifurcation of the common iliac arteries and performed aortogram demonstrating indicated findings at the groin. At that point we then removed the pigtail over the wire and then we gave protamine and nitro through the flexor sheath. Pressure was held patient tolerated the procedure well.

RADIOGRAPHIC SUPERVISION INTERPRETATION
(There was not a radiologist present at any point during procedure.)

Arch aortogram demonstrated an angulated type 3 arch with extensive atherosclerotic and calcification and of disease. The left common carotid artery appeared to have an ostial stenosis. The left internal carotid artery appeared to be occluded with runoff and patency of the left carotid artery

Right subclavian angiogram: Demonstrated patency of thyrocervical trunk and its branches as well as the IMA. The vertebral artery appeared to have an ostial high significant stenosis.

Right carotid angiogram: Demonstrated severe stenosis at the ICA takeoff near the bulb about 85-90% stenosis. External carotid appeared to be patent.

Abdominal aortogram: Abdominal aortogram demonstrated extensive calcification and tapering with extensive aortic occlusive disease of the infrarenal aorta. The patient had occlusion of the common iliac arteries at the distal aspect as well as occlusion of both the external iliac and hypogastric arteries. There was reconstitution at the bifurcation of the SFA and profunda on the proximal common femoral artery through pelvic collaterals. There was noted mesenteric collaterals noted. The IMA appeared to be not filling and occluded. The estimated profunda appeared to be patent with minimal stenosis.


Impression: Right high-grade ICA stenosis, left ICA occlusion, extensive aortic occlusive disease with reconstitution at bilateral common femoral arteries, occluded IMA.

Estimated Blood Loss: Minimal

Complications: None

Disposition: Stable

36223-RT
75625
36140
Do we also need 36215-RT or would this be included in 36223-RT? Thanks.
 

Jim Pawloski

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Ann Arbor
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Pls see our codes at the end of the procedure report. We are all new to IR and would love another opinion.

Angiogram Procedure Note

Pre-Operative Diagnosis:
1. Peripheral Artery Disease with disabling claudication
2. Left carotid occlusion
3. Right carotid stenosis, severe

Post-Operative Diagnosis: Same, aortic occlusive disease

Procedure:
1. Left common femoral artery access under ultrasound guidance
2. Left radial artery access under ultrasound guide
3. Arch aortogram
4. Right carotid and subclavian artery angiogram
5. Abdominal aortogram with lateral views

Anesthesia Type: Moderate sedation

Procedure Details:
After informed was obtained patient was taken to the cath lab. Placed in the supine position. Bilateral groins and left arm was prepped in the usual sterile fashion. We began by accessing the left common artery under ultrasound guidance. We advanced the micro sheath was over the wire and then placed a 5 French sheath in the left common femoral artery. We then advanced the soft angled Glidewire over a glide cath but there was noted to be a flush occlusion near without the left external iliac artery was located. We tried to get across with this occlusion but after multiple attempts failed. We then decided to get access in the left brachial artery under ultrasound guidance. We advanced a slender 4 French sheath over the wire and then I soft angled glide wire into the arch aortic arch. We heparinized the patient at this point and obtained ACTs. We then advanced a angled pigtail into the aorta aorta ascending aorta and performed arch aortogram see findings. We then selected right subclavian artery with a soft vu catheter and performed a angiogram see findings. We then used the same catheter in selected the right common carotid artery and then performed a angiogram. At that point we then withdrew our catheter and advanced our soft angled Glidewire into the descending thoracic aorta down to the abdominal aorta and then advanced a pigtail catheter over the wire performed an abdominal aortogram. See findings. We then took lateral shots. See findings. We then advanced the pigtail into the infrarenal aorta before the bifurcation of the common iliac arteries and performed aortogram demonstrating indicated findings at the groin. At that point we then removed the pigtail over the wire and then we gave protamine and nitro through the flexor sheath. Pressure was held patient tolerated the procedure well.

RADIOGRAPHIC SUPERVISION INTERPRETATION
(There was not a radiologist present at any point during procedure.)

Arch aortogram demonstrated an angulated type 3 arch with extensive atherosclerotic and calcification and of disease. The left common carotid artery appeared to have an ostial stenosis. The left internal carotid artery appeared to be occluded with runoff and patency of the left carotid artery

Right subclavian angiogram: Demonstrated patency of thyrocervical trunk and its branches as well as the IMA. The vertebral artery appeared to have an ostial high significant stenosis.

Right carotid angiogram: Demonstrated severe stenosis at the ICA takeoff near the bulb about 85-90% stenosis. External carotid appeared to be patent.

Abdominal aortogram: Abdominal aortogram demonstrated extensive calcification and tapering with extensive aortic occlusive disease of the infrarenal aorta. The patient had occlusion of the common iliac arteries at the distal aspect as well as occlusion of both the external iliac and hypogastric arteries. There was reconstitution at the bifurcation of the SFA and profunda on the proximal common femoral artery through pelvic collaterals. There was noted mesenteric collaterals noted. The IMA appeared to be not filling and occluded. The estimated profunda appeared to be patent with minimal stenosis.


Impression: Right high-grade ICA stenosis, left ICA occlusion, extensive aortic occlusive disease with reconstitution at bilateral common femoral arteries, occluded IMA.

Estimated Blood Loss: Minimal

Complications: None

Disposition: Stable

36223-RT
75625
36140
Do we also need 36215-RT or would this be included in 36223-RT? Thanks.

36215 is bundled in the 36223-RT code. You also need to add -LT,59 to 36140.
HTH,
Jim Pawloski, CIRCC
 
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