Angiography of bilateral lower extremities through right femoral access?

AgnieszkaMarek

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Glesns Falls, NY
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Hello,

I struggle with this case, anyone can advise me ?
I think 36247, 36248x2 for one leg, how about the other ?
:unsure:
PREOPERATIVE DIAGNOSIS: Bilateral lower extremity claudication.

POSTOPERATIVE DIAGNOSIS: Bilateral lower extremity claudication.


PROCEDURE: The patient was brought to the angiogram suite and prepped and draped in the
usual fashion. After infiltration of 10 mL 1% Lidocaine using ultrasound guidance the right
femoral artery was accessed using a micropuncture needle. A micropuncture wire was
introduced and needle eventually exchanged for a 4-French Brite tip sheath. Universal flush
catheter was advanced over a Bentson wire and a standard AP aortogram was performed.

The AP aortogram showed single patent bilateral renal arteries. The infrarenal abdominal
aorta was atherosclerotic and somewhat mildly ectatic. Next, the catheter was positioned in
the aortic bifurcation and standard RAO and LAO views were performed. These showed patent
bilateral common iliac, external iliac and hypogastric arteries. Next, the right common
iliac artery was selected using Bentson wire and Universal flush catheter advanced into the
left distal iliac, external iliac and common femoral artery.

Left leg angiogram was performed. This showed patent left common femoral and profunda
femoris artery although there was atherosclerotic plaque in left common femoral artery.
There was flush occlusion of the left superficial femoral artery. There was reconstitution
of the left popliteal artery at the level of the knee. Left below-knee popliteal artery was
patent. Left anterior tibial, tibial peroneal trunk, peroneal and posterior tibial arteries
were patent.

Following this the catheter was removed from the left external iliac artery and right leg
angiogram was performed. This showed patent right common femoral, profunda femoris artery.
Again, there was flush occlusion right superficial femoral artery with reconstitution right
below-knee popliteal artery via collaterals. The right anterior tibia, tibial peroneal
trunk, peroneal and posterior tibial arteries were patent.

Following this all catheters and wires were removed. Pressure was held to achieve
hemostasis. The patient tolerated the procedure well and was brought back to recovery in
stable condition.

IMPRESSIONS:
1. Single patent bilateral renal arteries.
2. Patent inferior abdominal aorta, patent bilateral common iliac, external iliac and
hypogastric arteries.
3. Patent left common femoral, profundus femoris artery but total occlusion of left
superficial femoral artery and reconstitution left below-knee popliteal artery via
collaterals with three vessel runoff to the left foot.
4. Patent right common femoral and profunda femoris artery but totally occluded right
superficial femoral artery, reconstitution right below-knee popliteal artery via
collaterals with three vessel runoff to the right foot.
 

Jim Pawloski

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Ann Arbor
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You have 36246-LT ( catheter in common femoral artery) 75716. Right leg imaging was performed thru the sheath and is not billable.
HTH,
Jim Pawloski, CIRCC
 

lhass

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Since the aorta was studied from two catheter positions (infrarenal aorta and aortic bifurcation) with findings of the bilateral renal arteries, inferior abdominal aorta and bilateral lower extremities it would be appropriate to report 75625 as well.
 

annewech

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I agree with Jim Pawloski and Ihass-Coding should be 75625 (aortogram) 36246 (cath placement in LT CFA) and 75716 (bilateral LE Angio.)
 
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