HELP!! LHC,Abdom Aortog,Iliac Stent

[sandya]

Hi...pt has Medicare. Pt had a LHC, abdom aortography for claudication/PAD, and then an iliac stent...93459-26(LHC + grafts), G0278(Abdom Aortography), 37221 (Iliac Stent). Am I close? thanks Sandy

 

[rebec26@juno.com]

Are you able to provide the documentation of the abdominal aortography?

 

[sandya]

notes for abdom aortography

hi...he performed the LHC +Grafts, then did the following:

I performed a lower abdominal aortography with a limited runoff into the
left lower extremity because of the patient's symptoms as well as
difficulty with access and a 60+ millimeter gradient between the central
aorta and the left CFA sheath pressure. The 5-French angled pigtail
catheter was inserted into the mid section of the abdominal aorta and an
anteroposterior projection run was performed with the inferior portion of
the abdominal aorta as well as the iliac system. This showed a focal 90%
stenosis in the proximal portion of the common iliac. There was
downstream filling of the left to right femoral?femoral bypass. This was
not further imaged at this time. There was diffuse moderate calcific
disease distal to this.

Given the patient's symptoms and the difficulty I had with crossing the
stenosis I did not think that she would be a candidate for return and
elective angioplasty. I consulted Dr. Wood who came into the room and
reviewed the images with me. He agreed that intervention was indicated and
we discussed technical details. We agreed that she did not need a complete
runoff study at this time. I spoke with the patient who gave consent. I
then went out to the Skylight holding area and obtained official written
consent from her husband and family.

The 4-French sheath in the left femoral artery was then exchanged out for
a 6-French sheath. This 0.035 inch wire was left in place across the
stenosis. A 6 mm balloon was inflated at the site. An angiogram was
performed through the balloon lumen as the tip of the balloon was in the
inferior portion of the abdominal aorta. This showed inadequate apposition
of plaque but an improved tract. Then a 7 x 39 mm Genesis stent was
deployed at the site with 1 inflation. This still appeared somewhat
undersized. An 8 mm balloon was inflated in the proximal portion of this
stent and into the aorta. Repeat angiography demonstrated excellent
apposition of plaque with no dissections. There was now less than or equal
to 10 mm gradient between the central and sheath pressures. I decided to
terminate the procedure at this point.