Carotid/Peripheral Angio

em2177

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San Gabriel Valley,CA
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REASON FOR EVALUATION: Carotid stenosis and peripheral arterial disease with
claudication.

HISTORY OF THE PRESENT ILLNESS: The patient is well-known to me. He is an
84-year-old gentleman with multiple cardiovascular risk factors and diffuse
cardiovascular disease. The patient has had a carotid ultrasound with
intermediate carotid stenosis. He has had no history of a CVA. The patient
has also had severe peripheral arterial disease, now complaining of increasing
leg pain, left greater than right, worse with exertion, and relieved by rest.
The patient has a history of 2 stents in his SFA in the previous. The patient
thus has been explained the risks, benefits, and alternatives of carotid and
cerebral angiography, followed by peripheral angiography and possible
angioplasty and stenting. The patient agrees to proceed. I have answered his
questions.

The patient was brought to the catheterization lab and prepped and draped in a
sterile fashion. Lidocaine was placed to the right common femoral area, and a
6-French sheath was placed to the right common femoral artery using Seldinger
technique. Angiography of the groin was performed. There was calcification of
the common femoral artery, and plan for manual pressure was thus planned.
Next a JR4 was placed to the right brachiocephalic, and a Glidewire was placed
to the right external carotid artery. The JR4 was telescoped to the right
common carotid artery. Wire was removed. Catheter was flushed per standard
protocol. Selective carotid angiography was performed. Next, cerebral
angiography was performed in both the lateral and AP cranial views. Next the
JR4 was brought back to selectively engage the left common carotid artery.
Selective common carotid artery angiography of the neck vessels was performed,
followed by cerebral angiography, both with multiple-view angiography. A JR4
was then removed.
Next a 6-French LIMA catheter was placed over the wire to the bifurcation of
the iliacs. It was brought to the bifurcation. Over the J wire it was
telescoped into the distal left external iliac. Catheter was flushed for
standard protocol. An angiography from the external iliac down the left SFA to
the level of the ankle was performed.
Catheter was then brought back to the left common iliac. Angiography of the
left iliac system was performed. The catheter was then brought to the right
common iliac. Angiography of the right iliac system was performed, and then
the catheter was removed. Angiography through the sheath was performed down
the right leg to the level of the right ankle. Manual pressure was then held
to the right groin with good groin hemostasis and no evidence of oozing,
bruising, or hematoma.
The patient tolerated the procedure well. I reviewed the findings with him.
There were no acute complications. The patient was discharged to endoscopy in stable fashion.

IMPRESSION:
1. Right common carotid artery is widely patent.
2. Right internal carotid artery has a 60% to 80% focal stenosis in its
proximal segment, just above the level of the right carotid bulb. The right
external carotid artery is widely patent and stable. There is normal
anterior middle cerebral arterial flow which is widely patent.
3. The left common carotid artery is widely patent. The left internal carotid
artery and left external carotid artery are widely patent with normal
cerebral flow of the anterior and middle cerebral arteries.
4. Bilateral iliacs are heavily calcified with less than 20% stenosis of the
proximal right common iliac.
5. On the right proximal SFA there is a 50% to 70% stenosis, which is heavily
calcified. Otherwise the SFA is widely patent. In the popliteal segment
the popliteal artery is widely patent. In the anterior tibial there is a
proximal 60% to 80% stenosis. Otherwise it is stable and extends to the
level of the foot. The peroneal branch is stable with good flow to the
level of the ankle. The posterior tibial artery is not visualized and
appears to be occluded.
6. The left SFA is widely patent. There are 2 stents, 1 in the proximal and 1
in the mid segment which are widely patent. There is less than 20%
stenosis of the SFA. Then a popliteal segment is widely patent with less
than 20% stenosis. Below knee the anterior tibial artery has diffuse
calcifications and evidence of slow flow. The peroneal is patent, and again
the posterior tibial artery is occluded.
 

CHaslam

Contributor
Messages
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Location
Lacey, WA
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carotid/peripheral angiography

We sometimes do these in the Cardiac Cath lab here, but they are usually attached to another procedure.

You would have a couple of proc codes 75680 for the bilateral internal carotid artery angiography, and 75716 for the bilateral lower extremity agniography.
 

Jim Pawloski

True Blue
Messages
1,347
Location
Ann Arbor
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Need assistance in coding this report.
Thank You!

REASON FOR EVALUATION: Carotid stenosis and peripheral arterial disease with
claudication.

HISTORY OF THE PRESENT ILLNESS: The patient is well-known to me. He is an
84-year-old gentleman with multiple cardiovascular risk factors and diffuse
cardiovascular disease. The patient has had a carotid ultrasound with
intermediate carotid stenosis. He has had no history of a CVA. The patient
has also had severe peripheral arterial disease, now complaining of increasing
leg pain, left greater than right, worse with exertion, and relieved by rest.
The patient has a history of 2 stents in his SFA in the previous. The patient
thus has been explained the risks, benefits, and alternatives of carotid and
cerebral angiography, followed by peripheral angiography and possible
angioplasty and stenting. The patient agrees to proceed. I have answered his
questions.

The patient was brought to the catheterization lab and prepped and draped in a
sterile fashion. Lidocaine was placed to the right common femoral area, and a
6-French sheath was placed to the right common femoral artery using Seldinger
technique. Angiography of the groin was performed. There was calcification of
the common femoral artery, and plan for manual pressure was thus planned.
Next a JR4 was placed to the right brachiocephalic, and a Glidewire was placed
to the right external carotid artery. The JR4 was telescoped to the right
common carotid artery. Wire was removed. Catheter was flushed per standard
protocol. Selective carotid angiography was performed. Next, cerebral
angiography was performed in both the lateral and AP cranial views. Next the
JR4 was brought back to selectively engage the left common carotid artery.
Selective common carotid artery angiography of the neck vessels was performed,
followed by cerebral angiography, both with multiple-view angiography. A JR4
was then removed.
Next a 6-French LIMA catheter was placed over the wire to the bifurcation of
the iliacs. It was brought to the bifurcation. Over the J wire it was
telescoped into the distal left external iliac. Catheter was flushed for
standard protocol. An angiography from the external iliac down the left SFA to
the level of the ankle was performed.
Catheter was then brought back to the left common iliac. Angiography of the
left iliac system was performed. The catheter was then brought to the right
common iliac. Angiography of the right iliac system was performed, and then
the catheter was removed. Angiography through the sheath was performed down
the right leg to the level of the right ankle. Manual pressure was then held
to the right groin with good groin hemostasis and no evidence of oozing,
bruising, or hematoma.
The patient tolerated the procedure well. I reviewed the findings with him.
There were no acute complications. The patient was discharged to endoscopy in stable fashion.

IMPRESSION:
1. Right common carotid artery is widely patent.
2. Right internal carotid artery has a 60% to 80% focal stenosis in its
proximal segment, just above the level of the right carotid bulb. The right
external carotid artery is widely patent and stable. There is normal
anterior middle cerebral arterial flow which is widely patent.
3. The left common carotid artery is widely patent. The left internal carotid
artery and left external carotid artery are widely patent with normal
cerebral flow of the anterior and middle cerebral arteries.
4. Bilateral iliacs are heavily calcified with less than 20% stenosis of the
proximal right common iliac.
5. On the right proximal SFA there is a 50% to 70% stenosis, which is heavily
calcified. Otherwise the SFA is widely patent. In the popliteal segment
the popliteal artery is widely patent. In the anterior tibial there is a
proximal 60% to 80% stenosis. Otherwise it is stable and extends to the
level of the foot. The peroneal branch is stable with good flow to the
level of the ankle. The posterior tibial artery is not visualized and
appears to be occluded.
6. The left SFA is widely patent. There are 2 stents, 1 in the proximal and 1
in the mid segment which are widely patent. There is less than 20%
stenosis of the SFA. Then a popliteal segment is widely patent with less
than 20% stenosis. Below knee the anterior tibial artery has diffuse
calcifications and evidence of slow flow. The peroneal is patent, and again
the posterior tibial artery is occluded.
Hi,

You have 36216-rt, 36215-lt-59, 75671, 75680, 36246-lt-59, and 75716. (billing for hospital) Add modifier -26 for the professional aspect.
HTH,
Jim Pawloski
 
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