armedical
Contributor
This is the craziest operative report I have ever tried to code....AND now Medicare has a weird denial...HELPReport: Vascular Study
Date of Study:
Interpreting Physician: Dr Y
Physicians Present: Dr X & Dr Y (two separate practices)
Procedures Performed;
1. Selective angiogram of the right lower extremity
2. Selective angiogram of the left lower extremity
3. Intravascular ultrasound (IVUS) of the right lower extremity
4. Intravascular ultrasound of the left lower extremity
5. Viabahn endoprosthesis endovascular intervention of the right SFA and popliteal aneurysm
6. Endovascular intervention Viabahn endograft to the left SFA and popliteal lower extremity popliteal aneurysm.
We coded for Dr. Y billed Medicare submitted OP; Medicare denied CO-251stating " The attachment/other documentation content received did not contain the content required to process this claim or service"
35141 RT62
35141 LT6259
35151 RT62
35151 LT6259
34812-62
37250
37251
Description:
The patient was brought...and underwent general anesthesia per Anesthesia. Dr. X made 2 bilateral groin incisions for exposure to the right common femoral arteries. Antegrade access was gained with a 5-French sheath in both legs. We then took a Terumo run-through wire and cannulated the anterior tibial artery on the right lower extremity. After angiography was performed, we then took an IVUS catheter to gain intravascular measurements for Viabahn sizes. Next, we took a Glide wire Advantage and placed it in the anterior tibial and sequentially placed a distal 6 x 5 overlap with an 8 x 10 overlap with another 8 x 10 overlap with a 8 x 5 mm Viabahn endoprosthesis throught the right popliteal and SFA. Angiography at this point showed a small Endoleak. A 8 x 80 balloon was used to expand the joint spaces between all the Viabahn stents. Final angiography in the right system was performed with excellent angiographic result with no aneurysmal dilation or endoleak and there was 3 vessel runoff in leg. We then took a Terumo Glide wire Advantage down the anterior tibial on the left side. We first put a 5 x 6 mm Viabahn with appeared to migrate upward into the aneurysm sac. We decided to crush the stent. We then subsequently took a 6 x 10 and placed it across the popliteal artery and deployed it. We then rewired the vessel, taking the wire out of the migrated stent down the previously placed 6 x 10 stent and 2 sequential 7 x 10 Viabahn stents up into the distal and mid SFA. Final angiography was performed with an excellent result with 3 - vessel runoff. Case was concluded at this time with surgical closure to the groins bilaterally.