Help with Procedure code PLEASE!!!!!!

Coastal Coder

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Good Afternoon,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 placement75952-26

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 aspectsof infrarenal abdominal aorta and minor stenoses of both common 1hac artenes but study otherw1sefairly normal vascular anatomy of the bilateral lower extremity arteries.PROCEDURE PERFORMED: Percutaneous retrograde access of right common femoral vein andthen of the right common femoral artery to abdominal aorta; Abdominal aortogram; Bilateral lowerextremity angiography; Stenting and balloon angioplasty of the mid aspects of the infrarenalabdominal 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-limitingclaudication symptoms of both legs. had abnormal resting and post-exercise ankle brachialindices bilaterally and had had a CTA study of her abdominal aorta last year showing evidence ofinfrarenal aortic aortic stenosis and possibly mild iliac artery disease. Angiographic study andpossible endovascular intervention was advised.

FINDINGS AT SURGERY: See postop diagnoses above. The patient's right common femoral veinwas entered first by micropuncture technique and wire left in place to aide in access to the arterywhich was very close to the vein and this was also accessed by micropuncture technique. Thestenotic area of the aorta was stented using a 12 mm diameter x 40 mm length self-expanding stentand this was "ironed" into place with a 10 mm diameter x 4 em length balloon with a good technicalresult noted on follow-up angios


.DESCRIPTION OF PROCEDURE: The patient was placed on the fluoroscopic table in theangiographic operating room suite in the supine position. Both groin areas were prepped withChloraPrep solution and then draped in a sterile manner.The patient's right common femoral artery pulsations were identified by palpation and a localanesthetic of 0.25% plain Marcaine and 1% plain Lidocaine in a 1:1 ratio was infiltrated into theoverlying subcuticular and subcutaneous tissues. Percutaneous retrograde access of the rightfemoral vein was accomplished using micropuncture needle and wire and fluoroscopic imaging toidentify bony landmarks. The small wire was left in place as a radiographic marker and then the rightcommon femoral artery was able to be accessed percutaneously with the micropuncture needle andthe assistance of fluoroscopy. The small wire was removed from the vein and inserted into the arteryvia 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 theright iliac system. The micropuncture sheath was exchanged ~h1s'wire for a 6-French Pinnacleintroducer sheath. The sheath flushed with heparinized saline solution and direct pressure was heldover 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 wireremoved. The SOS catheter was positioned near the L 1/L2 junction under fluoroscopy. The patientthen underwent an abdominal aortogram study utilizing slight left anterior-oblique projection. Findingsweftr§'s meiitioriea above in the postoperative diagnoses.The ca~era was•rmurne8 to a" straight anterior-posterior projection. The sos catheter wasrepositioned into the distal abdominal aorta under fluoroscopic imaging. Following this, pelvicangiography and bilateral lower extremity angiography utilizing bolus-chase technique wasperformed. 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 lengthself-expanding stent under fluoroscopic guidance. Once this was in place, the stent was furtherexpanded and "ironed" into place using a 10 mm diameter x 4 em length angioplasty balloon.The sos catheter was reinserted aos; area of stenting. Followup angios weredone show1ng a good tech meal resu1t:The guidewire was reinserted and the SOS catheter removed. The skin at the entry site of thePinnacle 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-awayintroducer sheath for a StarCiose device. Once this was in place, the guidewire was removed.A StarCiose device was right common femoral artery. Manual pressureon the groin area was then i before relaxing this. There was satisfactoryhemostasis of the puncture site. Therefore, the puncture site was dressed with a folded gauzesponge secured with an outer Tegaderm dressing.This completed the procedure. The patient was transferred to a stretcher and transported to therecovery area in stable condition.The patient tolerated the procedure well. The estimated blood loss was only around 25 mi. Thepatient received 115 ml of contrast during the procedure and had no obvious contrast reaction.
 
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I am also not well-versed in the arena of vascular coding, but you are 100% correct about the AAA codes. Unfortunately I can't help you get drilled down to specific codes, but my suggestion is to look at the codes in the 362XX area. I know that's not an actual answer, but maybe it'll help you get to where you need to be going.
 
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