JRhea0715
Contributor
I don't code very many carotid stents and was hoping someone could please verify my codes for me? We have no prior angios on file. I'm thinking this should be coded as: 36221-XU, 37215, 76937. Thank you in advance for your help! =)
The patient is symptomatic and considered high risk for carotid endarterectomy due to age and neck osteoarthritis s/p surgery with poor neck mobility. Using lidocaine 1% for local anesthesia and the modified Seldinger technique with ultrasound guidance and a micropunture needle, a 5F sheath was placed retrograde in the right femoral artery. Overa a Versacore wire, a 5F pigtail catheter was manipulated into the aortic arch. Arch aortography was performed with power injection of Isovue and digital subtraction. Arch aortography demonstrated a type 1 aortic arch. A 5F glide Simmons 2 catheter was manipulated into the left common carotid artery. Selective cervical and cerebral angiography was performed with hand injection of Isovue and digital subtraction. Angiography demonstrated a 95% left internal carotid artery stenosis. The upper limit of the lesion was at C2, and the total lesion length is approximately 25mm. There was minimal calcification.
Heparin was administered and ACT was confirmed to be therapeutic. Over a Supracore wire, a 6F sheath was manipulated into the left common carotid artery. A Nav6 distal embolic protection device was manipulated into the distal internal carotid artery and deployed. Predilation was performed with Viatrac 4x20 mm balloon at 8 ATM. Stenting was performed with a 8-10x40mm Abbott Xact self-expanding nitinol stent. Postdilation was performed with a Viatrac 5x20mm balloon at 8 ATM. After confirming antegrade flow, the distal embolic protection device was retrieved. Final angiography demonstrated patent stent with no residual stenosis and brisk distal perfusion. Following the procedure, the femoral artery was closed with a 6F Perclose Proglide.
The patient is symptomatic and considered high risk for carotid endarterectomy due to age and neck osteoarthritis s/p surgery with poor neck mobility. Using lidocaine 1% for local anesthesia and the modified Seldinger technique with ultrasound guidance and a micropunture needle, a 5F sheath was placed retrograde in the right femoral artery. Overa a Versacore wire, a 5F pigtail catheter was manipulated into the aortic arch. Arch aortography was performed with power injection of Isovue and digital subtraction. Arch aortography demonstrated a type 1 aortic arch. A 5F glide Simmons 2 catheter was manipulated into the left common carotid artery. Selective cervical and cerebral angiography was performed with hand injection of Isovue and digital subtraction. Angiography demonstrated a 95% left internal carotid artery stenosis. The upper limit of the lesion was at C2, and the total lesion length is approximately 25mm. There was minimal calcification.
Heparin was administered and ACT was confirmed to be therapeutic. Over a Supracore wire, a 6F sheath was manipulated into the left common carotid artery. A Nav6 distal embolic protection device was manipulated into the distal internal carotid artery and deployed. Predilation was performed with Viatrac 4x20 mm balloon at 8 ATM. Stenting was performed with a 8-10x40mm Abbott Xact self-expanding nitinol stent. Postdilation was performed with a Viatrac 5x20mm balloon at 8 ATM. After confirming antegrade flow, the distal embolic protection device was retrieved. Final angiography demonstrated patent stent with no residual stenosis and brisk distal perfusion. Following the procedure, the femoral artery was closed with a 6F Perclose Proglide.
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