aunderhill
Networker
| Hello, I am hoping for some help in coding Cath and stent. Thank you in advance! There was a US arterial duplex bilateral lower extremity performed 5 months prior to this procedure. Does this count as prior diagnostic imaging? The codes I came up with are: 37221, LT Stent in external iliac 36200- Cath to aorta 75625- adominal aortogram 37252-IVUS 76937 -Is this allowed? 99152,59 - Mod sedation Also should 75716 be billed? Or 37221 LT 37252-IVUS 76937 -Is this allowed? 99152,59 - Mod sedation Also should 75716 be billed PROCEDURES: |
| 1. Abdominal aortogram with peripheral runoff. |
| 2. Selective left iliofemoral angiography. |
| 3. PTA and stent placement of the left external iliac artery. |
| INDICATION: Peripheral vascular disease with claudication. |
| SUMMARY OF FINDINGS: |
| 1. The left external iliac had a 90% stenosis after the common iliac stent. |
| 2. The left common iliac stent is patent. |
| 3. The right common iliac stent is patent. |
| 4. The right common femoral has a subtotal stenosis, which is heavily calcified. |
| 5. There is 2-vessel runoff bilaterally. |
| RECOMMENDATION: Common femoral endarterectomy via surgery. |
| DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was taken to the cardiac catheterization lab. Conscious sedation was provided by trained nurse for a total of 2 hours. The left groin area was prepped and draped in sterile fashion. Approximately 10 mL of 1% lidocaine were used for local anesthesia. Using ultrasonic guidance and micropuncture technique, the left common femoral artery was cannulated with a 5-French sheath. An Omniflush catheter was advanced to the abdominal aorta. Abdominal aortography was performed. It was brought down to the bifurcation. Automated bolus chase angiography was performed on both legs. The images were reviewed. The Omniflush was removed. The 5-French sheath was exchanged for a 7-French sheath. Intravascular ultrasound was performed on the iliofemoral system for proper sizing. The IVUS catheter was removed. The lesion was predilated with a 6 x 80 mm balloon. Next, an 8 x 40 mm self-expanding stent was aligned with minimal overlap of the previously placed common iliac stent and deployed. Post-dilatation was performed with a 7 mm balloon at the overlap of the 2 stents. Final angiography was performed. The sheath was removed and a Perclose device was placed for good hemostasis. The patient tolerated the procedure well. There were no complications. He was transferred in stable condition to the recovery area. |
| RESULTS: |
| Abdominal aorta: Eccentric 60% stenosis in the infrarenal aorta consistent with atherosclerotic plaque. SMA: Patent. |
| Left renal: Patent. |
| Right renal and accessory renal arteries: Small caliber and patent. |
| Inferior mesenteric: Patent. |
| RIGHT LEG: |
| Common iliac: Patent stent with 10-20% in-stent restenosis. |
| The internal iliac: Is covered by the stent and heavily diseased, but patent. |
| External iliac: Diffuse mild disease. |
| Common femoral: Heavy calcification subtotal stenosis. |
| Profunda femoral: Small arising from the diseased section of the common femoral. |
| Superficial femoral: Patent without significant disease. |
| Popliteal patent: Without significant disease. |
| Anterior tibial: Bifurcates off of the popliteal, it is patent to the foot. |
| Peroneal tibial trunk: Patent. |
| Posterior tibial: Is patent to the foot. |
| Peroneal: Is not seen. |
| LEFT LEG: |
| Common iliac: Stent is patent without significant in-stent restenosis. |
| Internal iliac: Patent with diffuse disease. |
| External iliac: 90% proximal stenosis. |
| Common femoral: Patent. |
| Profunda femoral: Patent. |
| Superficial femoral: Patent with mild disease. |
| Popliteal: Patent. |
| Anterior tibial: High bifurcation off the popliteal, patent to the distal leg. |
| Peroneal: Arises off the anterior tibial and is patent to the mid calf. |
| Posterior tibial: Patent to foot. |
| Post stent external iliac 0% residual, brisk flow in the vessel. The internal iliac remains patent. |