margaret fahy
Guru
Guys,
Can you help me with this. forgot to include report in previous request.
Not sure of documentation re angiography of right renal branch....but if i don't code for the angiography, then i'd have to code for the catheterization?
Is it 36253-rt and 36251-lt and then 36245 for catheterization of inferior rt.branch...where dr. did the angioplasty?
And then the angioplasty.....35471/75966.
Need help to get the angiographies prior to intervention coded.
Thanks so much.
Margie
PROCEDURE: The skin of the right groin was prepped and draped in
sterile fashion. Using US guidance a 21 gauge needle was
inserted in the right common femoral artery. Once arterial blood
return was obtained a .018" Mandril wire was placed into the
artery and advanced to the distal abdominal aorta. The needle
was removed and replaced with a 5 French micropuncture
sheath/dilator set. The wire was sized up to a .035" wire, and a
5 French vascular sheath was placed into the artery. Via the
arterial sheath a 5 French pigtail catheter was advanced into the
mid abdominal aorta and digital subtraction angiography was
performed. The pigtail catheter was removed and exchanged for a
5 French angled catheter.
This catheter was manipulated until it was in the right main
renal artery and DSA was performed in multiple obliquities. A
wire was advanced into an inferior branch of the right main renal
artery, and angioplasty was performed with a 1.5 mm balloon
inflated to 1.7 mm. Post-angioplasty angiogram was performed.
25 mcg of nitroglycerin was then injected into the right main
renal artery.
The catheter was then manipulated into the left main renal artery
and DSA was performed in multiple obliquities.
The catheter was manipulated until it was in the right accessory
renal artery and DSA was performed. Angioplasty was performed in
the distal right accessory renal artery with a 1.5 mm balloon
inflated to 1.7 mm. 25 mcg of nitroglycerin was then injected
into the right accessory renal artery. Post-angioplasty
angiogram was performed.
Completion right main renal arteriogram was performed. The
catheter and sheath were then removed and manual compression was
applied until hemostasis was achieved. A sterile occlusive
dressing was applied at the site. There were no complications
and the patient left the IR suite in stable condition. Dr.
Cahill was present for the entire procedure.
FINDINGS:
1. Ultrasound of the right groin shows an anechoic and pulsatile
right common femoral artery.
2. Aortogram shows two right renal arteries and three left renal
arteries. No stenosis of the left renal arteries, although the
accessory left renal arteries are tortuous proximally. Stenosis
of the intraparenchymal portion of the right accessory renal
artery, and intraparenchymal portion of an inferior branch of the
main right renal artery.
3. Right main renal arteriogram shows stenosis of the
intraparenchymal portion of an inferior branch of the main right
renal artery, with delayed perfusion of a segment of the lower
pole of the right kidney, but no infarct.
4. Post angioplasty right renal arteriogram shows slightly
improved stenosis and perfusion.
5. Right accessory renal arteriogram shows Supply to the lower
pole of the kidney, with stenosis of the intraparenchymal portion
of the right accessory renal artery. No proximal stenosis or
kinking.
6. Post angioplasty right accessory renal arteriogram shows
slightly improved stenosis.
7. Left renal arteriogram shows supply to the upper and
interpolar region of the left kidney. No stenosis.
Permanent ultrasound and fluoroscopic images were obtained and
stored in the PACS system.
IMPRESSION
Can you help me with this. forgot to include report in previous request.
Not sure of documentation re angiography of right renal branch....but if i don't code for the angiography, then i'd have to code for the catheterization?
Is it 36253-rt and 36251-lt and then 36245 for catheterization of inferior rt.branch...where dr. did the angioplasty?
And then the angioplasty.....35471/75966.
Need help to get the angiographies prior to intervention coded.
Thanks so much.
Margie
PROCEDURE: The skin of the right groin was prepped and draped in
sterile fashion. Using US guidance a 21 gauge needle was
inserted in the right common femoral artery. Once arterial blood
return was obtained a .018" Mandril wire was placed into the
artery and advanced to the distal abdominal aorta. The needle
was removed and replaced with a 5 French micropuncture
sheath/dilator set. The wire was sized up to a .035" wire, and a
5 French vascular sheath was placed into the artery. Via the
arterial sheath a 5 French pigtail catheter was advanced into the
mid abdominal aorta and digital subtraction angiography was
performed. The pigtail catheter was removed and exchanged for a
5 French angled catheter.
This catheter was manipulated until it was in the right main
renal artery and DSA was performed in multiple obliquities. A
wire was advanced into an inferior branch of the right main renal
artery, and angioplasty was performed with a 1.5 mm balloon
inflated to 1.7 mm. Post-angioplasty angiogram was performed.
25 mcg of nitroglycerin was then injected into the right main
renal artery.
The catheter was then manipulated into the left main renal artery
and DSA was performed in multiple obliquities.
The catheter was manipulated until it was in the right accessory
renal artery and DSA was performed. Angioplasty was performed in
the distal right accessory renal artery with a 1.5 mm balloon
inflated to 1.7 mm. 25 mcg of nitroglycerin was then injected
into the right accessory renal artery. Post-angioplasty
angiogram was performed.
Completion right main renal arteriogram was performed. The
catheter and sheath were then removed and manual compression was
applied until hemostasis was achieved. A sterile occlusive
dressing was applied at the site. There were no complications
and the patient left the IR suite in stable condition. Dr.
Cahill was present for the entire procedure.
FINDINGS:
1. Ultrasound of the right groin shows an anechoic and pulsatile
right common femoral artery.
2. Aortogram shows two right renal arteries and three left renal
arteries. No stenosis of the left renal arteries, although the
accessory left renal arteries are tortuous proximally. Stenosis
of the intraparenchymal portion of the right accessory renal
artery, and intraparenchymal portion of an inferior branch of the
main right renal artery.
3. Right main renal arteriogram shows stenosis of the
intraparenchymal portion of an inferior branch of the main right
renal artery, with delayed perfusion of a segment of the lower
pole of the right kidney, but no infarct.
4. Post angioplasty right renal arteriogram shows slightly
improved stenosis and perfusion.
5. Right accessory renal arteriogram shows Supply to the lower
pole of the kidney, with stenosis of the intraparenchymal portion
of the right accessory renal artery. No proximal stenosis or
kinking.
6. Post angioplasty right accessory renal arteriogram shows
slightly improved stenosis.
7. Left renal arteriogram shows supply to the upper and
interpolar region of the left kidney. No stenosis.
Permanent ultrasound and fluoroscopic images were obtained and
stored in the PACS system.
IMPRESSION