Iris24
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I am struggling with Selective Catheterization, Angiogram + Endovascular Revascularization together.
Let me give you a scenario.
PROCEDURES PERFORMED:
1. Ultrasound-guided catheterization of the right common femoral artery.
2. Aortic angiogram with interpretation.
3. Left lower extremity angiogram with interpretation and third-order catheterization of the anterior tibial artery.
4. Percutaneous balloon angioplasty of the below-knee popliteal artery and proximal anterior tibial artery with a 3.5 x 60 mm balloon.
The right common femoral artery was catheterized under ultrasound guidance with a micropuncture kit using a modified Seldinger technique. A right femoral angiogram was performed to confirm catheterization of the common femoral artery. After confirming good position of the micropuncture sheath, a Storq wire was advanced into the abdominal aorta under fluoroscopy and the micropuncture sheath replaced by a short 5-French sheath. An Omniflush catheter was advanced into the abdominal aorta over the Storq wire under fluoroscopy and an aortoiliac angiogram was performed. Next, the left common femoral artery was catheterized with a combination of the Omniflush catheter and a stiff angled Glidewire. A left lower extremity angiogram was performed, identifying the segmental occlusion of the popliteal artery. At this time, the patient received 10,000 units of heparin IV. The short 5-French sheath was replaced by a 6-French x 65 cm sheath over the Storq wire. The area of occlusion was easily crossed with an 0.018 Advantage wire and the wire was advanced into the anterior tibial artery. A balloon angioplasty of the popliteal and proximal anterior tibial artery was performed with a 3.5 x 60 mm balloon. The post-procedure angiogram showed excellent angiographic results without significant residual stenosis and no evidence of embolism or any complication. The wire and sheath were removed and the puncture site was closed with a 6-French Angio-Seal. After deploying the Angio-Seal, good flow through the right lower extremity was confirmed with a Doppler device. The patient tolerated the procedure well without complications and was transferred to the recovery room in stable condition.
From my understanding, selective catheterization is already included in Endovascular revascularization codes. But when they performed together with Angiogram, I got a bit confused.
How would you guys code this case?
Let me give you a scenario.
PROCEDURES PERFORMED:
1. Ultrasound-guided catheterization of the right common femoral artery.
2. Aortic angiogram with interpretation.
3. Left lower extremity angiogram with interpretation and third-order catheterization of the anterior tibial artery.
4. Percutaneous balloon angioplasty of the below-knee popliteal artery and proximal anterior tibial artery with a 3.5 x 60 mm balloon.
The right common femoral artery was catheterized under ultrasound guidance with a micropuncture kit using a modified Seldinger technique. A right femoral angiogram was performed to confirm catheterization of the common femoral artery. After confirming good position of the micropuncture sheath, a Storq wire was advanced into the abdominal aorta under fluoroscopy and the micropuncture sheath replaced by a short 5-French sheath. An Omniflush catheter was advanced into the abdominal aorta over the Storq wire under fluoroscopy and an aortoiliac angiogram was performed. Next, the left common femoral artery was catheterized with a combination of the Omniflush catheter and a stiff angled Glidewire. A left lower extremity angiogram was performed, identifying the segmental occlusion of the popliteal artery. At this time, the patient received 10,000 units of heparin IV. The short 5-French sheath was replaced by a 6-French x 65 cm sheath over the Storq wire. The area of occlusion was easily crossed with an 0.018 Advantage wire and the wire was advanced into the anterior tibial artery. A balloon angioplasty of the popliteal and proximal anterior tibial artery was performed with a 3.5 x 60 mm balloon. The post-procedure angiogram showed excellent angiographic results without significant residual stenosis and no evidence of embolism or any complication. The wire and sheath were removed and the puncture site was closed with a 6-French Angio-Seal. After deploying the Angio-Seal, good flow through the right lower extremity was confirmed with a Doppler device. The patient tolerated the procedure well without complications and was transferred to the recovery room in stable condition.
From my understanding, selective catheterization is already included in Endovascular revascularization codes. But when they performed together with Angiogram, I got a bit confused.
How would you guys code this case?