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we billed these codes for angiography and the 36247 was denied by BCBS stating Experimental/Investigational. Corporate Medical policy 6.01.15 intravascular brachytherapy. We just did an angiography. Are there code changes? Any help will be appreciated
INDICATION: Intermittent claudication, left lower extremity.
PROCEDURE: Right common femoral arterial axis with selective catheter placement into the contralateral iliac artery with bilateral lower extremity runoff with supervision and interpretation.
HISTORY OF PRESENT ILLNESS: The patient is a 63-year-old with a history of diabetes, hypertension, chronic renal disease with significant left lower extremity claudication. He has tried ambulatory therapy without much improvement. He underwent noninvasive imaging after he developed left leg and thigh pain with ambulation with as little as 20 feet depending on the day. As such, with significant impact on his quality of life he underwent bilateral lower extremity runoff to evaluate the extent of his peripheral artery disease.
DESCRIPTION OF PROCEDURE: Informed consent was obtained. The patient understood the risks, benefits and alternatives of the procedure and agreed to proceed with the procedure. The right groin was prepped in the usual sterile fashion and 2% lidocaine infused subcutaneously until adequate anesthesia was obtained. Right common femoral artery was accessed using modified Seldinger technique using micropuncture technique and a 6-French sheath was placed. A Contra catheter was navigated across the aortic bifurcation and selectively placed into the ostium of the external iliac artery. Selective injections were made in both the right and left external iliac arteries as well as through the right common femoral sheath to perform lower extremity studies and evaluation of the left and right bilateral lower extremities. At the conclusion of the procedure, manual compression was used for hemostasis.
FINDINGS: There was moderate atherosclerosis seen at the aortic bifurcation. The right common iliac had moderate disease. The right external iliac had moderate disease. Right internal iliac had moderate disease.
Right common femoral artery had mild-to-moderate disease. There was extensive adventitial calcification seen in the right superficial femoral artery with moderate approximately 50-60% disease seen throughout its proximal segment. There was modest disease seen in the popliteal with 3-vessel runoff distally. The deep profunda had moderate disease as well.
Selective engagement of the left external iliac demonstrated total occlusion. There was extensive collateralization extending from the left internal iliac artery extending to the profunda system of which there was mild contrast ghosting of the SFA distal to the takeoff of the common femoral artery. It was difficult qualify any stenosis seen in the distal lower extremity due to antegrade injection with only collateralization.
SUMMARY: Total occlusion of the left external iliac artery just after the takeoff of the internal iliac artery with collateralization to the left lower extremity via the internal iliac and the profunda. Moderate disease on the right lower extremity as described.
CLINICAL PATHWAY: the patient will undergo evaluation and consideration for potential vascular surgical intervention for this symptom-limiting lesion. We thank you for the opportunity to participate in the care of this fine gentleman.
DX I70.212
Procedure Codes:
1.36140 ESTABLISH ACCESS TO ARTERY. 59
2.36247 PLACE CATHETER IN ARTERY.
3.75716 ARTERY X-RAYS, ARMS/LEGS. Modifiers: 26, 59
INDICATION: Intermittent claudication, left lower extremity.
PROCEDURE: Right common femoral arterial axis with selective catheter placement into the contralateral iliac artery with bilateral lower extremity runoff with supervision and interpretation.
HISTORY OF PRESENT ILLNESS: The patient is a 63-year-old with a history of diabetes, hypertension, chronic renal disease with significant left lower extremity claudication. He has tried ambulatory therapy without much improvement. He underwent noninvasive imaging after he developed left leg and thigh pain with ambulation with as little as 20 feet depending on the day. As such, with significant impact on his quality of life he underwent bilateral lower extremity runoff to evaluate the extent of his peripheral artery disease.
DESCRIPTION OF PROCEDURE: Informed consent was obtained. The patient understood the risks, benefits and alternatives of the procedure and agreed to proceed with the procedure. The right groin was prepped in the usual sterile fashion and 2% lidocaine infused subcutaneously until adequate anesthesia was obtained. Right common femoral artery was accessed using modified Seldinger technique using micropuncture technique and a 6-French sheath was placed. A Contra catheter was navigated across the aortic bifurcation and selectively placed into the ostium of the external iliac artery. Selective injections were made in both the right and left external iliac arteries as well as through the right common femoral sheath to perform lower extremity studies and evaluation of the left and right bilateral lower extremities. At the conclusion of the procedure, manual compression was used for hemostasis.
FINDINGS: There was moderate atherosclerosis seen at the aortic bifurcation. The right common iliac had moderate disease. The right external iliac had moderate disease. Right internal iliac had moderate disease.
Right common femoral artery had mild-to-moderate disease. There was extensive adventitial calcification seen in the right superficial femoral artery with moderate approximately 50-60% disease seen throughout its proximal segment. There was modest disease seen in the popliteal with 3-vessel runoff distally. The deep profunda had moderate disease as well.
Selective engagement of the left external iliac demonstrated total occlusion. There was extensive collateralization extending from the left internal iliac artery extending to the profunda system of which there was mild contrast ghosting of the SFA distal to the takeoff of the common femoral artery. It was difficult qualify any stenosis seen in the distal lower extremity due to antegrade injection with only collateralization.
SUMMARY: Total occlusion of the left external iliac artery just after the takeoff of the internal iliac artery with collateralization to the left lower extremity via the internal iliac and the profunda. Moderate disease on the right lower extremity as described.
CLINICAL PATHWAY: the patient will undergo evaluation and consideration for potential vascular surgical intervention for this symptom-limiting lesion. We thank you for the opportunity to participate in the care of this fine gentleman.
DX I70.212
Procedure Codes:
1.36140 ESTABLISH ACCESS TO ARTERY. 59
2.36247 PLACE CATHETER IN ARTERY.
3.75716 ARTERY X-RAYS, ARMS/LEGS. Modifiers: 26, 59