Wiki Balloon Angioplasty peroneal artery and balloon angio of tibioperoneal trunk.

[bailsb]

The provider is asking for number of codes that are bundled but can be unbundled with mods. Any help is appreciated. The provider wants: 36247, 37229, 37252, 75625, 75726. 75774.

Using micropuncture kit the right femoral artery was cannulated and 5 french sheath was placed in the right femoral artery. We then advanced an omni flush catheter to the level of L4 Distal abdominal aortic angiography was completed. After this, we advanced a Bentson wire into the SFA and the omni Flush was then selectively engaged in the SFA. Angiography was then completed. We then performed an angiography of the left lower extremity. After finding significant amount of stenosis in the tibioperoneal trunk and the peroneal artery being completely occluded, we proceeded with the intervention of artery. We advanced a CXI cath and stiff angled glide cath into the peroneal and we were able to enter in thh true lumen distally. After that, we advanced the CXI cath into the dital peroneal vessel. We then exchanged out in favor of Viper wire and performed artherectomy of the tibioperoneal trunk. After this, we swapped out in favor of an 0.018 Treasure 12 wire and performed balloon angioplasy with a 2.5 x 30 cm balloon of the peroneal artery. We performed balloon angioplasy in the this vessel. Afterh that, we advanced a 4.0 x 30 balloon and performed balloon angioplasty in the TP trunk and then we performed IVUS of the tibioperoneal trunk.

Thank you for taking a look.

bb

 

[jtuominen]

Using micropuncture kit the right femoral artery was cannulated and 5 french sheath was placed in the right femoral artery. We then advanced an omni flush catheter to the level of L4 Distal abdominal aortic angiography was completed (so far 36200, without anatomical landmarks provided to show the full abdominal aorta was studied, or a findings section delineating what was found during this study, I wouldn’t award a angiography code for this at this point) After this, we advanced a Bentson wire into the SFA and the omni Flush was then selectively engaged in the SFA (so far 36247). Angiography was then completed. We then performed an angiography of the left lower extremity(75710). After finding significant amount of stenosis in the tibioperoneal trunk and the peroneal artery being completely occluded, we proceeded with the intervention of artery. We advanced a CXI cath and stiff angled glide cath into the peroneal (still 36247) and we were able to enter in thh true lumen distally. After that, we advanced the CXI cath into the dital peroneal vessel. We then exchanged out in favor of Viper wire and performed artherectomy of the tibioperoneal trunk (at this point in note 37229) After this, we swapped out in favor of an 0.018 Treasure 12 wire and performed balloon angioplasy with a 2.5 x 30 cm balloon of the peroneal artery (now that we have treated the peroneal artery as well, the Tibioperonal trunk is considered an proximal extension of this vessel, so Id still code 37229 only). We performed balloon angioplasy in the this vessel. (this sentence, not clear, would need to know what vessel is being discussed here) Afterh that, we advanced a 4.0 x 30 balloon and performed balloon angioplasty in the TP trunk and then we performed IVUS of the tibioperoneal trunk (37252).

Final codes I would award with this documentation:
75710-XU: (as long as no previous CTA or contrast study is on file prior to this exam for the body area, without a change in symptoms since that visit)
37229: for the atherectomy and angioplasty of the TP trunk and PTA of peroneal artery. (See page 264 of CPT Book 2018 Professional Edition for further explanation here of the TP relationship to other vessels when multiple interventions performed)
37252: IVUS of the TP trunk

I would not award:
75625: because a study of the full abdominal aorta was not documented (from the level of the renal arteries, downward, or at least no findings provided to suggest a full study)
36247: Is bundled into 37229 in all instances of single access angiography-to-interventions, unless there are two access points, where one is used for the angiography and the other used for intervention
75726: This code is used for visceral angiogram, so I would not utilize it here/Im not seeing support for it
75774: Because a good anatomical map was not provided/findings provided of the abdominal angiogram (that may have really been a pelvic/upper leg study from aortic bifurcation), I would not provide 75774 in addition to 75710, and consider 75710 to be the angiogram performed later on at the level of the SFA.