Help with Procedure code PLEASE!!!!!!

Coastal Coder

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Good Morning,

I am totally up in the air on this one any help would be greatly appreciated. I have attached the op report. My Physician wants to bill codes
1. 36200 - R Fem access
2. 75625-26 -Abdominal aortogram
3. 75716-26 - Bilat extremity angios
4. 34800- Aortic angio and stent placement
75952-26
I don't think he can charge 34800 and 75952 as these are for AAA repair. I am not a vascular guru so any help with this would be great!!!!!



OPERATIVE REPORT

PREOPERATIVE DIAGNOSES: PAD with lifestyle-limiting claudication symptoms of both legs.


POSTOPERATIVE DIAGNOSES: PAD with moderately high grad~- 65-75% stenosis of mid aspects

of infrarenal abdominal aorta and minor stenoses of both common 1hac artenes but study otherw1se
fairly normal vascular anatomy of the bilateral lower extremity arteries.
PROCEDURE PERFORMED: Percutaneous retrograde access of right common femoral vein and
then of the right common femoral artery to abdominal aorta; Abdominal aortogram; Bilateral lower
extremity angiography; Stenting and balloon angioplasty of the mid aspects of the infrarenal
abdominal aorta.


ACCESS: Right common femoral artery; access control via StarCiose device.

CONTRAST: 115m I contrast; no obvious contrast reaction.


INDICATIONS: The patient recently regarding lifestyle-limiting

claudication symptoms of both legs. had abnormal resting and post-exercise ankle brachial
indices bilaterally and had had a CTA study of her abdominal aorta last year showing evidence of
infrarenal aortic aortic stenosis and possibly mild iliac artery disease. Angiographic study and
possible endovascular intervention was advised.


FINDINGS AT SURGERY: See postop diagnoses above. The patient's right common femoral vein

was entered first by micropuncture technique and wire left in place to aide in access to the artery
which was very close to the vein and this was also accessed by micropuncture technique. The
stenotic area of the aorta was stented using a 12 mm diameter x 40 mm length self-expanding stent
and this was "ironed" into place with a 10 mm diameter x 4 em length balloon with a good technical
result noted on follow-up angios.
DESCRIPTION OF PROCEDURE: The patient was placed on the fluoroscopic table in the
angiographic operating room suite in the supine position. Both groin areas were prepped with
ChloraPrep solution and then draped in a sterile manner.
The patient's right common femoral artery pulsations were identified by palpation and a local
anesthetic of 0.25% plain Marcaine and 1% plain Lidocaine in a 1:1 ratio was infiltrated into the
overlying subcuticular and subcutaneous tissues. Percutaneous retrograde access of the right
femoral vein was accomplished using micropuncture needle and wire and fluoroscopic imaging to
identify bony landmarks. The small wire was left in place as a radiographic marker and then the right
common femoral artery was able to be accessed percutaneously with the micropuncture needle and
the assistance of fluoroscopy. The small wire was removed from the vein and inserted into the artery
via the micropuncture'needle. The needle was exchanged over the wire for a micropuncture sheath.
· The small wire was removed and a 0.035" Bentson guidewire was inserted and advanced up the
right iliac system. The micropuncture sheath was exchanged ~h1s'wire for a 6-French Pinnacle
introducer sheath. The sheath flushed with heparinized saline solution and direct pressure was held
over the right groin area for a few minutes for additional hemostasis.
A SOS Omni flush catheter was advanced over the wire to the upper abdominal aorta and the wire
removed. The SOS catheter was positioned near the L 1/L2 junction under fluoroscopy. The patient
then underwent an abdominal aortogram study utilizing slight left anterior-oblique projection. Findings
weftr§'s meiitioriea above in the postoperative diagnoses.
The ca~era was•rmurne8 to a" straight anterior-posterior projection. The sos catheter was
repositioned into the distal abdominal aorta under fluoroscopic imaging. Following this, pelvic
angiography and bilateral lower extremity angiography utilizing bolus-chase technique was
performed. Findings were as mentioned above in the postoperative diagnoses.
At this time, the SOS catheter was cannulated with the 0.035" guidewire and the catheter removed.
The patient was given a dose of IV heparin of 3000 units by the nurse anesthetist.
The infrarenal aortic area of stenosis underwent placement of a 12 mm diameter x 40 mm length
self-expanding stent under fluoroscopic guidance. Once this was in place, the stent was further
expanded and "ironed" into place using a 10 mm diameter x 4 em length angioplasty balloon.
The sos c~theter was reinserted aos;l~?Ji'l@%' i'liOMAJJ:le area of stenting. Followup angios were
done show1ng a good tech meal resu1t:
The guidewire was reinserted and the SOS catheter removed. The skin at the entry site of the
Pinnacle sheath in the right groin area was incised with scalpel and the subcutaneous tissues were
dilated with a hemostat. The sheath was then exchanged over the guidewire for the peel-away
introducer sheath for a StarCiose device. Once this was in place, the guidewire was removed.
A StarCiose device was right common femoral artery. Manual pressure
on the groin area was then i before relaxing this. There was satisfactory
hemostasis of the puncture site. Therefore, the puncture site was dressed with a folded gauze
sponge secured with an outer Tegaderm dressing.
This completed the procedure. The patient was transferred to a stretcher and transported to the
recovery area in stable condition.
The patient tolerated the procedure well. The estimated blood loss was only around 25 mi. The
patient received 115 ml of contrast during the procedure and had no obvious contrast reaction.
 

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