Cryoplasty and cpt 37224

drobinson1

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I need help with this report. I want to use 37224 but I'm not sure if I can use any other codes. It just seems like a lot is going on and I don't want to under-code it.

Reason For Study: PVD

History: 58-year-old female with decreased pressures from PVR. She is status post bilateral fem-pop bypass. She had cryoplasty of her right distal fem-pop in 6/25/2007, and there is suspicion of restenosis.

Via the left common femoral artery, a 5 French sheath was placed, through which a 5 French Omni Flush catheter was advanced into the abdominal aorta. Abdominal aortogram was performed, followed by bilateral leg angiogram.

The angiogram demonstrates moderate irregularity of the abdominal aorta without focal stenosis.

On the right, there is nonstenotic common iliac artery, external iliac artery and internal iliac artery, unchanged from prior study. Common femoral artery and profunda femoral artery are nonstenotic. There is nonstenotic proximal anastomosis of fem-pop bypass graft arising from the proximal SFA. Remainder of the native SFA is occluded. The femoropopliteal bypass graft is nonstenotic except at the distal anastomosis where there is a 70 to 80% short segment stenosis at the level of the surgical clips. A prominent size branch vessel is demonstrated at the anastomosis. Popliteal artery and trifurcation are patent. There is three-vessel runoff into the foot.

On the left, there is mild 30% ostial stenosis of the common iliac artery, which is slightly more conspicuous than on the prior study. The remainder of the common iliac artery is nonstenotic. There is mild disease of the internal iliac artery. The external iliac artery is nonstenotic. There is patent common femoral artery. The left femoral popliteal bypass graft arises from the proximal SFA. There is a focal 50 or 60% stenosis at the proximal left SFA, which is similar to that demonstrated previously. The profunda femoral artery is nonstenotic. The femoral popliteal bypass graft is patent and nonstenotic. There is mild disease of the popliteal artery without focal stenosis and is unchanged from prior study. There is patent trifurcation and three-vessel runoff into the foot.

Utilizing a Bentson guidewire, the right common iliac artery was selectively catheterized and the catheter was advanced to the level of the common femoral artery. Right femoral angiogram confirmed the moderate short segment stenosis at the distal anastomosis.

The catheter and sheath were exchanged over an Amplatz superstiff guidewire for a 6 French long sheath, which was advanced to the right common femoral artery. A 5 French cryoplasty balloon of 5 mm x 4 cm was advanced over the guidewire through the distal anastomotic stenosis. Cryoplasty was performed across the stenosis and after 2 such cryoplasty inflations, there was significant improvement. A total of 7 cryoplasty inflations at this site were performed. Completion angiogram shows minimal shouldering at the transition between the graft and the native artery. At the end of the procedure, the catheter and sheath were read withdrawn to the left common iliac artery. The sheath was removed after normalization of the PTT. Hemostasis was readily achieved at 20 minutes hand compression time using Syvek seal. There is II+ dorsalis pedis and both feet and II+ posterior tibial pulses in both feet after hemostasis was achieved.

Impression:

1. Right leg runoff shows patent iliac arteries common femoral artery and profunda femoral artery. There is moderate short segment restenosis at the distal anastomosis of the right femoral/popliteal bypass graft. Prior cryoplasty was performed on 6/25/2007. There is patent popliteal artery patent trifurcation with three-vessel runoff to foot.

2. Left leg runoff shows 30% ostial stenosis of the common iliac artery which is slightly more conspicuous than on prior study. There is focal 50 to 60% stenosis of the proximal left SFA, which was demonstrated previously and is slightly more conspicuous than on the prior study. The graft is patent. There is mild narrowing at the distal anastomosis, which is unchanged from prior study. There is patent, trifurcation and three-vessel runoff into the foot.

3. Cryoplasty at the right fem-pop bypass graft was performed with 5 mm x 4 cm cryoplasty balloon 7 times. There is nonstenotic appearance with minimal shouldering at the anastomosis.
 

Jim Pawloski

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I need help with this report. I want to use 37224 but I'm not sure if I can use any other codes. It just seems like a lot is going on and I don't want to under-code it.

Reason For Study: PVD

History: 58-year-old female with decreased pressures from PVR. She is status post bilateral fem-pop bypass. She had cryoplasty of her right distal fem-pop in 6/25/2007, and there is suspicion of restenosis.

Via the left common femoral artery, a 5 French sheath was placed, through which a 5 French Omni Flush catheter was advanced into the abdominal aorta. Abdominal aortogram was performed, followed by bilateral leg angiogram.

The angiogram demonstrates moderate irregularity of the abdominal aorta without focal stenosis.

On the right, there is nonstenotic common iliac artery, external iliac artery and internal iliac artery, unchanged from prior study. Common femoral artery and profunda femoral artery are nonstenotic. There is nonstenotic proximal anastomosis of fem-pop bypass graft arising from the proximal SFA. Remainder of the native SFA is occluded. The femoropopliteal bypass graft is nonstenotic except at the distal anastomosis where there is a 70 to 80% short segment stenosis at the level of the surgical clips. A prominent size branch vessel is demonstrated at the anastomosis. Popliteal artery and trifurcation are patent. There is three-vessel runoff into the foot.

On the left, there is mild 30% ostial stenosis of the common iliac artery, which is slightly more conspicuous than on the prior study. The remainder of the common iliac artery is nonstenotic. There is mild disease of the internal iliac artery. The external iliac artery is nonstenotic. There is patent common femoral artery. The left femoral popliteal bypass graft arises from the proximal SFA. There is a focal 50 or 60% stenosis at the proximal left SFA, which is similar to that demonstrated previously. The profunda femoral artery is nonstenotic. The femoral popliteal bypass graft is patent and nonstenotic. There is mild disease of the popliteal artery without focal stenosis and is unchanged from prior study. There is patent trifurcation and three-vessel runoff into the foot.

Utilizing a Bentson guidewire, the right common iliac artery was selectively catheterized and the catheter was advanced to the level of the common femoral artery. Right femoral angiogram confirmed the moderate short segment stenosis at the distal anastomosis.

The catheter and sheath were exchanged over an Amplatz superstiff guidewire for a 6 French long sheath, which was advanced to the right common femoral artery. A 5 French cryoplasty balloon of 5 mm x 4 cm was advanced over the guidewire through the distal anastomotic stenosis. Cryoplasty was performed across the stenosis and after 2 such cryoplasty inflations, there was significant improvement. A total of 7 cryoplasty inflations at this site were performed. Completion angiogram shows minimal shouldering at the transition between the graft and the native artery. At the end of the procedure, the catheter and sheath were read withdrawn to the left common iliac artery. The sheath was removed after normalization of the PTT. Hemostasis was readily achieved at 20 minutes hand compression time using Syvek seal. There is II+ dorsalis pedis and both feet and II+ posterior tibial pulses in both feet after hemostasis was achieved.

Impression:

1. Right leg runoff shows patent iliac arteries common femoral artery and profunda femoral artery. There is moderate short segment restenosis at the distal anastomosis of the right femoral/popliteal bypass graft. Prior cryoplasty was performed on 6/25/2007. There is patent popliteal artery patent trifurcation with three-vessel runoff to foot.

2. Left leg runoff shows 30% ostial stenosis of the common iliac artery which is slightly more conspicuous than on prior study. There is focal 50 to 60% stenosis of the proximal left SFA, which was demonstrated previously and is slightly more conspicuous than on the prior study. The graft is patent. There is mild narrowing at the distal anastomosis, which is unchanged from prior study. There is patent, trifurcation and three-vessel runoff into the foot.

3. Cryoplasty at the right fem-pop bypass graft was performed with 5 mm x 4 cm cryoplasty balloon 7 times. There is nonstenotic appearance with minimal shouldering at the anastomosis.
The only other code you can add is 75716 - Bilateral Extremity Arteriogram. The PTA charge includes catheter selection. Also, since there is no discription of the renal arteries, you can't bill for an aortogram.
HTH,
Jim Pawloski, CIRCC
 
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