Wiki Help with Peripheral

[Chelsea1]

Need help coding out this peripheral please. New to lowers.
Thank's

1. Left common femoral arterial access with sheath placement
2. Right pedal access with sheath placement
3. Catheter placement abdominal aorta
4. Selective catheterization third order arterial branch leg
5. Arteriogram aortogram bilateral lower externally runoff
6. Angioplasty right common iliac artery utilizing a 6 mm x 6 cm angioplasty balloon
7. Angioplasty right external iliac artery utilizing a 6 mm x 16 mm drug-coated angioplasty balloon
8. Angioplasty and stent placement of the right superficial femoral and popliteal artery utilizing a 5 mm x 120 mm Supera stent followed by a 5 mm x 120 mm angioplasty balloon


Both right and left groins and right foot were then prepped and draped in routine sterile fashion.

Beginning on the left groin this was locally anesthetized with 1% lidocaine without epinephrine. Using duplex ultrasound were able to access the left common femoral guidewire advanced and a 5 French sheath placed over the guidewire. Left lower extremity runoff was then performed using the side port of the sheath.

Next guidewire was advanced to the L1-2 level Omni Flush catheter was reformed over a guidewire aspirated blood and flushed out with heparinized saline solution diagnostic aortogram iliofemoral arteriogram was then performed in AP and oblique positions. Attempts were then made to cross over to the contralateral right external iliac artery segment. As noted above our wire would preferentially travel into the right internal iliac artery. Despite a number of catheter and guidewire combinations we were not able to adequately navigate into the external iliac artery segment.

Next, we got access in the right pedal region at the ankle utilizing the posterior tibial artery guidewire was advanced and a 5 French sheath placed at this location. A guidewire was then navigated through the posterior tibial artery across the popliteal. Utilizing a combination of catheter and guidewire were able to navigate through the popliteal and SFA occlusion. We placed our catheter in the more proximal SFA and common femoral region to confirm luminal location. We then advanced our guidewire into the external and common iliac artery segment.


Both right and left groins and right foot were then prepped and draped in routine sterile fashion.

Beginning on the left groin this was locally anesthetized with 1% lidocaine without epinephrine. Using duplex ultrasound were able to access the left common femoral guidewire advanced and a 5 French sheath placed over the guidewire. Left lower extremity runoff was then performed using the side port of the sheath.

Next guidewire was advanced to the L1-2 level Omni Flush catheter was reformed over a guidewire aspirated blood and flushed out with heparinized saline solution diagnostic aortogram iliofemoral arteriogram was then performed in AP and oblique positions. Attempts were then made to cross over to the contralateral right external iliac artery segment. As noted above our wire would preferentially travel into the right internal iliac artery. Despite a number of catheter and guidewire combinations we were not able to adequately navigate into the external iliac artery segment.

Next, we got access in the right pedal region at the ankle utilizing the posterior tibial artery guidewire was advanced and a 5 French sheath placed at this location. A guidewire was then navigated through the posterior tibial artery across the popliteal. Utilizing a combination of catheter and guidewire were able to navigate through the popliteal and SFA occlusion. We placed our catheter in the more proximal SFA and common femoral region to confirm luminal location. We then advanced our guidewire into the external and common iliac artery segment.

Treatment then consisted of a combination of angioplasty and angioplasty and stent placement. As described above we treated first the common iliac artery segment followed by the right external iliac artery segment. The right external iliac artery segment utilized a drug-coated balloon. Finally the SFA and popliteal were treated with a combination of balloon angioplasty and stent placement. We utilized a 5 mm x 120 mm stent followed by 5 mm x 120 mm angioplasty balloon. Final completion showed excellent in-line flow on the right leg. This was also demonstrated through a pigtail catheter run in antegrade fashion from the aorta distally. Following our intervention, the right posterior tibial sheath was removed and a tibial band placed for hemostasis. The left groin sheath was removed and the puncture controlled with a minx closure which was hemostatic. Patient tolerated procedure well.

 

[Jim Pawloski]

Need help coding out this peripheral please. New to lowers.
Thank's

1. Left common femoral arterial access with sheath placement
2. Right pedal access with sheath placement
3. Catheter placement abdominal aorta
4. Selective catheterization third order arterial branch leg
5. Arteriogram aortogram bilateral lower externally runoff
6. Angioplasty right common iliac artery utilizing a 6 mm x 6 cm angioplasty balloon
7. Angioplasty right external iliac artery utilizing a 6 mm x 16 mm drug-coated angioplasty balloon
8. Angioplasty and stent placement of the right superficial femoral and popliteal artery utilizing a 5 mm x 120 mm Supera stent followed by a 5 mm x 120 mm angioplasty balloon


Both right and left groins and right foot were then prepped and draped in routine sterile fashion.

Beginning on the left groin this was locally anesthetized with 1% lidocaine without epinephrine. Using duplex ultrasound were able to access the left common femoral guidewire advanced and a 5 French sheath placed over the guidewire. Left lower extremity runoff was then performed using the side port of the sheath.

Next guidewire was advanced to the L1-2 level Omni Flush catheter was reformed over a guidewire aspirated blood and flushed out with heparinized saline solution diagnostic aortogram iliofemoral arteriogram was then performed in AP and oblique positions. Attempts were then made to cross over to the contralateral right external iliac artery segment. As noted above our wire would preferentially travel into the right internal iliac artery. Despite a number of catheter and guidewire combinations we were not able to adequately navigate into the external iliac artery segment.

Next, we got access in the right pedal region at the ankle utilizing the posterior tibial artery guidewire was advanced and a 5 French sheath placed at this location. A guidewire was then navigated through the posterior tibial artery across the popliteal. Utilizing a combination of catheter and guidewire were able to navigate through the popliteal and SFA occlusion. We placed our catheter in the more proximal SFA and common femoral region to confirm luminal location. We then advanced our guidewire into the external and common iliac artery segment.


Both right and left groins and right foot were then prepped and draped in routine sterile fashion.

Beginning on the left groin this was locally anesthetized with 1% lidocaine without epinephrine. Using duplex ultrasound were able to access the left common femoral guidewire advanced and a 5 French sheath placed over the guidewire. Left lower extremity runoff was then performed using the side port of the sheath.

Next guidewire was advanced to the L1-2 level Omni Flush catheter was reformed over a guidewire aspirated blood and flushed out with heparinized saline solution diagnostic aortogram iliofemoral arteriogram was then performed in AP and oblique positions. Attempts were then made to cross over to the contralateral right external iliac artery segment. As noted above our wire would preferentially travel into the right internal iliac artery. Despite a number of catheter and guidewire combinations we were not able to adequately navigate into the external iliac artery segment.

Next, we got access in the right pedal region at the ankle utilizing the posterior tibial artery guidewire was advanced and a 5 French sheath placed at this location. A guidewire was then navigated through the posterior tibial artery across the popliteal. Utilizing a combination of catheter and guidewire were able to navigate through the popliteal and SFA occlusion. We placed our catheter in the more proximal SFA and common femoral region to confirm luminal location. We then advanced our guidewire into the external and common iliac artery segment.

Treatment then consisted of a combination of angioplasty and angioplasty and stent placement. As described above we treated first the common iliac artery segment followed by the right external iliac artery segment. The right external iliac artery segment utilized a drug-coated balloon. Finally the SFA and popliteal were treated with a combination of balloon angioplasty and stent placement. We utilized a 5 mm x 120 mm stent followed by 5 mm x 120 mm angioplasty balloon. Final completion showed excellent in-line flow on the right leg. This was also demonstrated through a pigtail catheter run in antegrade fashion from the aorta distally. Following our intervention, the right posterior tibial sheath was removed and a tibial band placed for hemostasis. The left groin sheath was removed and the puncture controlled with a minx closure which was hemostatic. Patient tolerated procedure well.

I need a little more information on this report. What were the findings of the injection into the abdominal aortogram. It may change what I would code for the diagnostic portion of the procedure. And how much of the left leg was imaged, just the iliac portion or the full extremity.
Thanks,
Jim Pawloski, CIRCC

 

[Chelsea1]

I need a little more information on this report. What were the findings of the injection into the abdominal aortogram. It may change what I would code for the diagnostic portion of the procedure. And how much of the left leg was imaged, just the iliac portion or the full extremity.
Thanks,
Jim Pawloski, CIRCC

I appreciate the help!!!! Here is what I have. I would like to learn more on coding lowers. Can you suggest anything as to how I can go about learning more for coding? Thanks!!!!!


· Intraoperative Findings: Intraoperatively we performed a diagnostic aortogram and bilateral lower extremity runoff which identified the following.

Aortoiliac region: The abdominal aorta appears widely patent. It appears to branch normally into common iliac arteries. There are 2 stents in the right common iliac artery which extend from the common iliac artery almost to the groin level in through the external iliac artery. There are 2 areas of stenosis identified one in the common iliac artery and the second at the terminal and of the distal external iliac artery. These are both high-grade. The left common iliac and external iliac artery appear widely patent to the groin level.

Right leg: The right common femoral, and proximal superficial femoral appear patent at the groin level. The right SFA is then patent through the proximal third and then occludes. The popliteal artery is diseased at its proximal portion and then is patent across the knee joint. Two-vessel runoff is then seen to the foot and ankle region.

Left leg: The left common femoral and profundus appear patent at the groin level. There is a left femoral to popliteal artery bypass which appears widely patent onto the popliteal artery. Two-vessel runoff is seen through the foot and ankle region


Intraoperatively: We initially attempted to cross the common iliac artery lesions from the contralateral or left side. Our wire would preferentially navigate into the right internal iliac artery. Despite a number of catheter and guidewire combinations we could not navigate safely into the contralateral right common and external iliac artery.

We then elected to have pedal access on the right leg in a retrograde fashion. This was achieved through the posterior tibial artery and a guidewire was successfully navigated through the posterior tibial artery popliteal artery popliteal and SFA occlusion placing the guidewire in the common iliac artery on the right-hand side.

Treatment then consisted of a combination of angioplasty and angioplasty and stent placement. We performed angioplasty of the right common iliac artery and a area where there was to stent junctional overlap. This was performed with a 6 mm angioplasty balloon, we then performed angioplasty at the terminal end of the external iliac artery utilizing a drug-coated balloon. This was a 6 mm x 60 mm drug-coated balloon. Finally the SFA and popliteal artery reconstruction required a combination of angioplasty and stent placement. Utilized a 5 mm x 120 mm Supera stent followed by angioplasty utilizing a 5 mm angioplasty balloon.

Final completion arteriogram showed excellent in-line flow with good flow through the right common iliac external iliac into the femoral SFA popliteal and infrapopliteal vessels.
· Description of Procedure: Patient was brought to the special procedure room he was connected up to the appropriate monitoring devices insisting of heart rate, blood pressure, pulse oximetry.

Both right and left groins and right foot were then prepped and draped in routine sterile fashion.

Beginning on the left groin this was locally anesthetized with 1% lidocaine without epinephrine. Using duplex ultrasound were able to access the left common femoral guidewire advanced and a 5 French sheath placed over the guidewire. Left lower extremity runoff was then performed using the side port of the sheath.

Next guidewire was advanced to the L1-2 level Omni Flush catheter was reformed over a guidewire aspirated blood and flushed out with heparinized saline solution diagnostic aortogram iliofemoral arteriogram was then performed in AP and oblique positions. Attempts were then made to cross over to the contralateral right external iliac artery segment. As noted above our wire would preferentially travel into the right internal iliac artery. Despite a number of catheter and guidewire combinations we were not able to adequately navigate into the external iliac artery segment.

Next, we got access in the right pedal region at the ankle utilizing the posterior tibial artery guidewire was advanced and a 5 French sheath placed at this location. A guidewire was then navigated through the posterior tibial artery across the popliteal. Utilizing a combination of catheter and guidewire were able to navigate through the popliteal and SFA occlusion. We placed our catheter in the more proximal SFA and common femoral region to confirm luminal location. We then advanced our guidewire into the external and common iliac artery segment.

Treatment then consisted of a combination of angioplasty and angioplasty and stent placement. As described above we treated first the common iliac artery segment followed by the right external iliac artery segment. The right external iliac artery segment utilized a drug-coated balloon. Finally the SFA and popliteal were treated with a combination of balloon angioplasty and stent placement. We utilized a 5 mm x 120 mm stent followed by 5 mm x 120 mm angioplasty balloon. Final completion showed excellent in-line flow on the right leg. This was also demonstrated through a pigtail catheter run in antegrade fashion from the aorta distally. Following our intervention, the right posterior tibial sheath was removed and a tibial band placed for hemostasis. The left groin sheath was removed and the puncture controlled with a minx closure which was hemostatic. Patient tolerated procedure well.

 

[Chelsea1]

peripheral help please

I appreciate the help!!!! Here is what I have. I would like to learn more on coding lowers. Can you suggest anything as to how I can go about learning more for coding? Thanks!!!!!


· Intraoperative Findings: Intraoperatively we performed a diagnostic aortogram and bilateral lower extremity runoff which identified the following.

Aortoiliac region: The abdominal aorta appears widely patent. It appears to branch normally into common iliac arteries. There are 2 stents in the right common iliac artery which extend from the common iliac artery almost to the groin level in through the external iliac artery. There are 2 areas of stenosis identified one in the common iliac artery and the second at the terminal and of the distal external iliac artery. These are both high-grade. The left common iliac and external iliac artery appear widely patent to the groin level.

Right leg: The right common femoral, and proximal superficial femoral appear patent at the groin level. The right SFA is then patent through the proximal third and then occludes. The popliteal artery is diseased at its proximal portion and then is patent across the knee joint. Two-vessel runoff is then seen to the foot and ankle region.

Left leg: The left common femoral and profundus appear patent at the groin level. There is a left femoral to popliteal artery bypass which appears widely patent onto the popliteal artery. Two-vessel runoff is seen through the foot and ankle region


Intraoperatively: We initially attempted to cross the common iliac artery lesions from the contralateral or left side. Our wire would preferentially navigate into the right internal iliac artery. Despite a number of catheter and guidewire combinations we could not navigate safely into the contralateral right common and external iliac artery.

We then elected to have pedal access on the right leg in a retrograde fashion. This was achieved through the posterior tibial artery and a guidewire was successfully navigated through the posterior tibial artery popliteal artery popliteal and SFA occlusion placing the guidewire in the common iliac artery on the right-hand side.

Treatment then consisted of a combination of angioplasty and angioplasty and stent placement. We performed angioplasty of the right common iliac artery and a area where there was to stent junctional overlap. This was performed with a 6 mm angioplasty balloon, we then performed angioplasty at the terminal end of the external iliac artery utilizing a drug-coated balloon. This was a 6 mm x 60 mm drug-coated balloon. Finally the SFA and popliteal artery reconstruction required a combination of angioplasty and stent placement. Utilized a 5 mm x 120 mm Supera stent followed by angioplasty utilizing a 5 mm angioplasty balloon.

Final completion arteriogram showed excellent in-line flow with good flow through the right common iliac external iliac into the femoral SFA popliteal and infrapopliteal vessels.
· Description of Procedure: Patient was brought to the special procedure room he was connected up to the appropriate monitoring devices insisting of heart rate, blood pressure, pulse oximetry.

Both right and left groins and right foot were then prepped and draped in routine sterile fashion.

Beginning on the left groin this was locally anesthetized with 1% lidocaine without epinephrine. Using duplex ultrasound were able to access the left common femoral guidewire advanced and a 5 French sheath placed over the guidewire. Left lower extremity runoff was then performed using the side port of the sheath.

Next guidewire was advanced to the L1-2 level Omni Flush catheter was reformed over a guidewire aspirated blood and flushed out with heparinized saline solution diagnostic aortogram iliofemoral arteriogram was then performed in AP and oblique positions. Attempts were then made to cross over to the contralateral right external iliac artery segment. As noted above our wire would preferentially travel into the right internal iliac artery. Despite a number of catheter and guidewire combinations we were not able to adequately navigate into the external iliac artery segment.

Next, we got access in the right pedal region at the ankle utilizing the posterior tibial artery guidewire was advanced and a 5 French sheath placed at this location. A guidewire was then navigated through the posterior tibial artery across the popliteal. Utilizing a combination of catheter and guidewire were able to navigate through the popliteal and SFA occlusion. We placed our catheter in the more proximal SFA and common femoral region to confirm luminal location. We then advanced our guidewire into the external and common iliac artery segment.

Treatment then consisted of a combination of angioplasty and angioplasty and stent placement. As described above we treated first the common iliac artery segment followed by the right external iliac artery segment. The right external iliac artery segment utilized a drug-coated balloon. Finally the SFA and popliteal were treated with a combination of balloon angioplasty and stent placement. We utilized a 5 mm x 120 mm stent followed by 5 mm x 120 mm angioplasty balloon. Final completion showed excellent in-line flow on the right leg. This was also demonstrated through a pigtail catheter run in antegrade fashion from the aorta distally. Following our intervention, the right posterior tibial sheath was removed and a tibial band placed for hemostasis. The left groin sheath was removed and the puncture controlled with a minx closure which was hemostatic. Patient tolerated procedure well.

 

[Jim Pawloski]

What you have is access in the left femoral and a selective common iliac catheter position, so code 36245-RT,59. the imaging codes is 75716 for bilateral extremity arteriogram. Now for the intervention, the catheter codes are bundled into the intervention codes. So the common iliac was angioplastied (37220), then the external iliac was angioplastied (37222 is the add-on code). the femoral region was revascularized with angioplasty and stent. Angioplasty can stand alone, or it's part of stent placement or atherectomy codes. So in this case, you code 37226 for stent placement. The abdominal aortogram was not described, so 75625 or 75630 can be charged.

Thanks for the interesting case.
HTH,
Jim Pawloski, CIRCC