Wiki Angioplasty-Peripheral

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missadeel

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Chico, CA
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Can someone please advise me on the correct coding for this procedure. New physician with our group and this is the first time for this procedure. Thank you in advance.
MDeel


Procedures
Peripheral angiography
Angioplasty-peripheral

Pre Procedure Diagnosis
PAD (peripheral artery disease) (CMS/HCC) [I73.9]
Post Procedure Diagnosis
PAD (peripheral artery disease) (CMS/HCC) [I73.9]

Indications
PAD (peripheral artery disease) (CMS/HCC) [I73.9 (ICD-10-CM)]
Pain of left lower extremity due to ischemia [I99.8 (ICD-10-CM)]


Conclusion

  • 99% left common femoral stenosis.
  • Obstructive arterial disease of distal LLE with good collateral reconstitution.
  • .
  • INTERVENTION:
  • Successful percutaneous intervention of the left common femoral artery with a 7.0 x 60 mm DCB with <30% residual stenosis.
  • .
  • PLAN:
  • Continue AC for HIT and ASA.

Procedures Performed:
Distal aortogram with bilateral run-off
Left Lower Extremity peripheral angiography
Percutaneous intervention of left common femoral artery with drug-coated balloon

Bilateral groins were prepped and draped in a sterile manner.
The right femoral artery was accessed, using ultrasound guidance, with a micropuncture needled and a 5 Fr sheath was placed.
A Pigtail catheter was advanced to the distal aorta where a distal aortogram with bilateral run off was performed.

A Rim catheter and soft angled glidewire was used to cross over to the left iliac. A Destination sheath was advanced over a wire. LLE angiography was performed.

Argatroban bolus and drip were initiated given patients recent diagnosis of HIT and
A Miracle Bros 4 wire was advanced down the vessel beyond the 99% common femoral lesion.

A 3.0 x 20 mm balloon was used to perform angiography of the lesion. Then the area was treated with a 7.0 x 60 mm DCB was inflated to 6 atm for 3 minutes. Repeat angiography showed <30% residual stenosis and good flow.

At the end of the procedure, all equipment was removed and hemostasis of the right common femoral artery was achieved with an Angioseal device.

DISTAL AORTA - angiographically patent.
RIGHT COMMON ILIAC - angiographically patent.
RIGHT INTERNAL ILIAC - angiographically patent.
RIGHT EXTERNAL ILIAC - angiographically patent.
RIGHT COMMON FEMORAL - angiographically patent.

LEFT COMMON ILIAC - angiographically patent.
LEFT INTERNAL ILIAC - angiographically patent.
LEFT EXTERNAL ILIAC - angiographically patent.
LEFT COMMON FEMORAL - angiographically patent.
LEFT PROFUNDA- angiographically patent.
LEFT SFA - angiographically patent.
LEFT POPLITEAL- occluded.
LEFT ANTERIOR TIBIAL - occluded proximally then quickly reconstitutes.
LEFT POSTERIOR TIBIAL - occluded proximally then quickly reconstitutes.
LEFT PERONEAL - occluded proximally then quickly reconstitutes.
 
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You can bill for 75630, or you can bill 75716, but you can't bill for both. In this case, the doctor is looking at the left leg. The finding of the right leg is incidental, because of the injection from the distal aorta. So I would code 37224-LT, 75710-LT-59 for Lt extremity arteriogram and revascularization of fem-pop region via angioplasty
 
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