Question Atherectomy and balloon angioplasty L SFA and L popliteal

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Bradenton, FL
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Procedure Performed:

  • Ultrasound-guided bilateral femoral artery access.
  • Diagnostic Retrograde right iliac angiogram.
  • Diagnostic left lower extremity angiogram
  • Atherectomy and balloon angioplasty of the left superficial femoral artery and left popliteal artery
  • Angio-Seal closure of both femoral arteriotomies Type of Anesthesia Local with monitored anesthesia care

Description of Procedure: After informed consent patient was brought to the operating room table and placed supine. After IV sedation the groins were prepped and draped sterilely. An ultrasound probe was advanced sterilely onto the field. Ultrasound examination of the right common femoral artery was performed. There was a patent lumen. The iliac was known to be partially occluded. 1% lidocaine was infiltrated for local anesthesia. Micropuncture needle was inserted into the right common femoral artery and a guidewire advanced without difficulty. The micropuncture needle was exchanged for 4 French sheath. The 4 French sheath was upsized to a 6 French sheath over a J-wire. Diagnostic Retrograde right iliac angiogram was performed. I attempted to cross the occlusion with an angled Glidewire without success. As such, the ultrasound probe was used to examine the left common femoral artery. The left common femoral was patent. 1% lidocaine was infiltrated. A micropuncture needle was used to cannulate the left common femoral artery in an antegrade approach. Guidewire was advanced without difficulty. The micropuncture needle was exchanged for a 4 French sheath. The 4 French sheath was upsized to a 6 French sheath over a J-wire. The patient was heparinized. Diagnostic left lower extremity angiogram was performed. There was only hemodynamically significant stenosis in the left tibioperoneal trunk. There were multiple areas of moderate stenosis throughout the superficial femoral artery and popliteal artery on the left. An angled Glidewire was advanced across the occlusion in the tibioperoneal trunk and deep into the peroneal artery. The 6 French short sheath was exchanged for a 6 French by 45 cm destination catheter over the Glidewire. A Trail Blazer was advanced over the angled Glidewire. The Trail Blazer was used to exchange the angled Glidewire for a 4.0 spider wire which was positioned in the peroneal. A Hawk 1 M atherectomy device was chosen. Atherectomy was performed of the superficial femoral artery popliteal artery and tibioperoneal trunk. Multiple passes were made without difficulty. Repeat angiogram demonstrated significant improvement. The atherectomy device was withdrawn. A 3 mm x 40 mm chocolate balloon was used to perform balloon angioplasty of the tibioperoneal trunk. The popliteal and superficial femoral artery were treated 1st with a 5 mm x 120 mm chocolate balloon. Each chocolate balloon inflation was held for 1 minute. I then used a 6 mm x 150 mm InPact Admiral drug coated balloon to perform balloon angioplasty of the popliteal and superficial femoral arteries. Final angiogram demonstrated no residual stenosis whatsoever with excellent runoff through the peroneal and posterior tibial arteries. The delivery device for a 6 French Angio-Seal was positioned in the right common femoral artery over a J-wire and Angio-Seal deployed as per manufacturer's guidelines with excellent hemostasis. The spider wire was captured through a Trail Blazer and a Glidewire advanced in its place. The Trail Blazer was withdrawn. The destination catheter was withdrawn and replaced with the delivery device from a 6 French Angio-Seal. The Angio-Seal was deployed as per manufacture's guidelines with excellent hemostasis in the left common femoral arteriotomy. The patient tolerated the procedure well. Dry sterile dressings were applied. Patient was taken to the postanesthesia care unit stable.


I selected the following codes: 37229, 37225, 326140-XU, 75710-XU, 76937. Are these correct?
 

Jim Pawloski

True Blue
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1,517
Location
Ann Arbor
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2
I agree with your codes, but depending on the insurance, you may have to use modifier -59 and not -XU. You may want to also say what side was done. I code it 37229-LT, 37225-LT, 34140-RT,59, 75710-LT,59, 76937x2 so I don't get harassed by the third-party payors.

HTH,
Jim Pawloski, CIRCC
 
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