margaret fahy
Guru
Guys,
I have another report...same situation.
dr. looks at renals from the aorta...then does a selective renal angiogram...then angioplasty.....do i bill anything at all...like maybe just the RS&I for the Aortogram? Or do I bill only for the selective cath/dsa and the angioplasty?
PROCEDURE:
1. Ultrasound guided right common femoral artery access.
2. Abdominal aortogram.
3. Selective catheterization of left renal artery and angiogram.
4. Angioplasty of the left renal artery using 4 mm and 5 mm
monorail balloon catheters.
5. Post angioplasty angiogram of the left renal artery and
abdominal aorta.
7. Hemostasis with manual compression.
PROCEDURE IN DETAILS: 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" Nitrex wire was placed into the
artery and advanced to the distal abdominal aorta. The needle was
removed, the tract was dilated and a 5 French 45 cm curved
vascular sheath was placed into the artery and advanced into the
abdominal aorta. Then a 5 French 70 cm pigtail catheter was
advanced into the proximal abdominal aorta and angiography of the
abdominal aorta and renal arteries in oblique view was obtained
utilizing digital subtraction angiography. Different types of
catheters including C1, and Sos Omni were used to catheterize the
left renal artery but were unsuccessful. At the end selective
catheterization of the left renal artery was performed utilizing
4 French rim catheter. Then left renal angiogram was obtained
using digital subtraction angiography.
FINDINGS:
AORTOGRAM:
The abdominal aorta: The abdominal aorta demonstrated diffuse
small smooth caliber compatible with the reported history of
coarctation of the aorta. Evaluation of the celiac and superior
mesenteric arteries is limited. There is no significant
discrepancy in renal size. Renal perfusion is symmetric without
significant focal defect. The venous phase demonstrates normal
renal veins with normal suprarenal IVC.
LEFT RENAL ARTERY ANGIOGRAM: Single left renal artery is
identified. There is severe short segment stenosis involving the
proximal 1 cm of the main left renal artery associated with post
stenosis dilatation. There is no significant stenosis noted in
the intra-renal branches. There is no vascular malformation or
aneurysm.
RIGHT RENAL ARTERY: Single right renal artery is identified.
There is probably mild stenosis involving the origin of the right
main renal artery. The intrarenal branches of the right renal
artery are unremarkable. There is no evidence of vascular
malformation or aneurysm.
LEFT RENAL ANGIOPLASTY:
The images were reviewed carefully and the measurements were
performed. A dose of heparin was given intravenously. Selective
catheterization of the left renal artery was performed utilizing
4 French rim catheter as mentioned above. Then a 014 approach
wire was advanced through the catheter into the left main renal
artery. The rim catheter was removed. Angioplasty was performed
utilizing 4 mm monorail balloon catheter (inflated to 4.4 mm at
12 atm.) and 5 mm monorail balloon catheter (inflated to 5.4 mm
at 14 atm.). The waist was noted during balloon inflation with
significant, incomplete effacement. Post angioplasty angiogram
through the sheath demonstrated significant radiologic
improvement of the left renal artery stenosis without evidence of
dissection or thrombosis.
The balloon and the wire were removed and a 5 French pigtail
catheter was advanced into the proximal abdominal aorta and
angiogram was obtained. This demonstrated patent abdominal aorta
and left renal artery without evidence of thrombosis, dissection
or extravasation.
The sheath was 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. was present for
the entire procedure.
Permanent fluoroscopic and US images were obtained and stored in
the PACS system.
IMPRESSION
IMPRESSION
1.Diffuse small smooth caliber of the abdominal aorta in keeping
with the reported history of coarctation of the aorta.
I have another report...same situation.
dr. looks at renals from the aorta...then does a selective renal angiogram...then angioplasty.....do i bill anything at all...like maybe just the RS&I for the Aortogram? Or do I bill only for the selective cath/dsa and the angioplasty?
PROCEDURE:
1. Ultrasound guided right common femoral artery access.
2. Abdominal aortogram.
3. Selective catheterization of left renal artery and angiogram.
4. Angioplasty of the left renal artery using 4 mm and 5 mm
monorail balloon catheters.
5. Post angioplasty angiogram of the left renal artery and
abdominal aorta.
7. Hemostasis with manual compression.
PROCEDURE IN DETAILS: 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" Nitrex wire was placed into the
artery and advanced to the distal abdominal aorta. The needle was
removed, the tract was dilated and a 5 French 45 cm curved
vascular sheath was placed into the artery and advanced into the
abdominal aorta. Then a 5 French 70 cm pigtail catheter was
advanced into the proximal abdominal aorta and angiography of the
abdominal aorta and renal arteries in oblique view was obtained
utilizing digital subtraction angiography. Different types of
catheters including C1, and Sos Omni were used to catheterize the
left renal artery but were unsuccessful. At the end selective
catheterization of the left renal artery was performed utilizing
4 French rim catheter. Then left renal angiogram was obtained
using digital subtraction angiography.
FINDINGS:
AORTOGRAM:
The abdominal aorta: The abdominal aorta demonstrated diffuse
small smooth caliber compatible with the reported history of
coarctation of the aorta. Evaluation of the celiac and superior
mesenteric arteries is limited. There is no significant
discrepancy in renal size. Renal perfusion is symmetric without
significant focal defect. The venous phase demonstrates normal
renal veins with normal suprarenal IVC.
LEFT RENAL ARTERY ANGIOGRAM: Single left renal artery is
identified. There is severe short segment stenosis involving the
proximal 1 cm of the main left renal artery associated with post
stenosis dilatation. There is no significant stenosis noted in
the intra-renal branches. There is no vascular malformation or
aneurysm.
RIGHT RENAL ARTERY: Single right renal artery is identified.
There is probably mild stenosis involving the origin of the right
main renal artery. The intrarenal branches of the right renal
artery are unremarkable. There is no evidence of vascular
malformation or aneurysm.
LEFT RENAL ANGIOPLASTY:
The images were reviewed carefully and the measurements were
performed. A dose of heparin was given intravenously. Selective
catheterization of the left renal artery was performed utilizing
4 French rim catheter as mentioned above. Then a 014 approach
wire was advanced through the catheter into the left main renal
artery. The rim catheter was removed. Angioplasty was performed
utilizing 4 mm monorail balloon catheter (inflated to 4.4 mm at
12 atm.) and 5 mm monorail balloon catheter (inflated to 5.4 mm
at 14 atm.). The waist was noted during balloon inflation with
significant, incomplete effacement. Post angioplasty angiogram
through the sheath demonstrated significant radiologic
improvement of the left renal artery stenosis without evidence of
dissection or thrombosis.
The balloon and the wire were removed and a 5 French pigtail
catheter was advanced into the proximal abdominal aorta and
angiogram was obtained. This demonstrated patent abdominal aorta
and left renal artery without evidence of thrombosis, dissection
or extravasation.
The sheath was 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. was present for
the entire procedure.
Permanent fluoroscopic and US images were obtained and stored in
the PACS system.
IMPRESSION
IMPRESSION
1.Diffuse small smooth caliber of the abdominal aorta in keeping
with the reported history of coarctation of the aorta.