Smb77
New
Procedures performed:
Arch and four-vessel angiography
Selective right brachiocephalic angiogram with runoff
Selective right carotid artery angiogram runoff
Selective left subclavian artery angiogram runoff
Selective left common carotid artery angiogram runoff
Ultrasound-guided right common femoral arterial access
I supervised administration moderate sedation, 30 minutes
Indication:
Asymptomatic, high-grade left internal carotid artery stenosis
Procedure in detail:
Patient was brought to the cardiac Cath Lab in a fasting and non-sedated state. Informed consent was signed and obtained. Using modified center technique and ultrasound guidance right common femoral artery was successfully punctured and a micro-puncture sheath was placed was upsized to a 6 French sheath followed by pigtail catheter the level of the ascending aorta to allow for angiography. This was exchanged for a VTK catheter which cannulated the right brachiocephalic artery left subclavian artery left common carotid artery to allow for selective angiography and intracerebral angiography. Thereafter equipment is removed patient tolerated procedure well.
Findings:
Type I aortic arch
Left internal carotid artery stenosis, 80% with significant concentric calcification
Patent left subclavian artery
Dominant right vertebral artery
Patent right internal carotid artery
Intracerebral crossover right to left flow
Conclusion:
In view of significant concentric calcification of left internal carotid artery; carotid endarterectomy is appropriate revascularization strategy.
I coded this as 36223-50, 76937....but physician also wanted the 36225 for subclavian angio as well....any feedback would be appreciated!
Arch and four-vessel angiography
Selective right brachiocephalic angiogram with runoff
Selective right carotid artery angiogram runoff
Selective left subclavian artery angiogram runoff
Selective left common carotid artery angiogram runoff
Ultrasound-guided right common femoral arterial access
I supervised administration moderate sedation, 30 minutes
Indication:
Asymptomatic, high-grade left internal carotid artery stenosis
Procedure in detail:
Patient was brought to the cardiac Cath Lab in a fasting and non-sedated state. Informed consent was signed and obtained. Using modified center technique and ultrasound guidance right common femoral artery was successfully punctured and a micro-puncture sheath was placed was upsized to a 6 French sheath followed by pigtail catheter the level of the ascending aorta to allow for angiography. This was exchanged for a VTK catheter which cannulated the right brachiocephalic artery left subclavian artery left common carotid artery to allow for selective angiography and intracerebral angiography. Thereafter equipment is removed patient tolerated procedure well.
Findings:
Type I aortic arch
Left internal carotid artery stenosis, 80% with significant concentric calcification
Patent left subclavian artery
Dominant right vertebral artery
Patent right internal carotid artery
Intracerebral crossover right to left flow
Conclusion:
In view of significant concentric calcification of left internal carotid artery; carotid endarterectomy is appropriate revascularization strategy.
I coded this as 36223-50, 76937....but physician also wanted the 36225 for subclavian angio as well....any feedback would be appreciated!