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Procedure in detail:
Pigtail cath positioned in mid AA, above renal arteries. Digital subtraction aortography was performed. Selective cannulation was performed of L and R renal arteries. Renal diagnostic curve cath was selected and used to advance into LRA. Selective arteriogram of LRA was performed, then multiple attempts were made to cannulate RRA. This was challenging because of high grade stenosis at ostium and unusual takeoff of RRA. Multiple caths were utilized ..Ultimately, doc selected a Cobra diagnostic cath and was ble to engage the R renal ostium. An RAO projection was performed w/selective renal angiography demonstrating no reflux from ostium and very tight stenosis. 60-70 m gradient noted across the renal ostium. This was reproduced several times and renal pullback was performed to confirm level of stenosis. Following pressure pullback, cath was reengaged. At this point, decision was mdade to do PTA and stent of RRA. Cath was positioned inside proximal RRA, a spatacore wire was davanced into distal Renal arter. The cath was withdrawn leaving the spartacore wire positioned for support. Then 6 french shepherds crook guide was positioned at ostiym. Then balloon dilatition was performed utilizing 4mmx20 m long slalom balloon. This was used to predilate the lesion to nominal pressure up to 10 atmospheres. Based on Slalom ballooon, it was felt that renal artery was approx 7mm diameter artery at its origin. Dr selected 7mm diameterx15mm long Cordis blue renal artery stent. This was placed at ostium and great care was taken to make sure stnt covered ostium of the lesion, stent was deployed and taken up 10 atmospheres. Following deployment, balloon was deflated and pulled back into aorta. To make sure ostium was well expanded and dilated the balloon was taken up to 12 atmospheres and ostium was bermished. Angiography was repeated demonstrationg excellent results and no complications.
Do you code? 36245, 36252-59, 37236
Procedure in detail:
Pigtail cath positioned in mid AA, above renal arteries. Digital subtraction aortography was performed. Selective cannulation was performed of L and R renal arteries. Renal diagnostic curve cath was selected and used to advance into LRA. Selective arteriogram of LRA was performed, then multiple attempts were made to cannulate RRA. This was challenging because of high grade stenosis at ostium and unusual takeoff of RRA. Multiple caths were utilized ..Ultimately, doc selected a Cobra diagnostic cath and was ble to engage the R renal ostium. An RAO projection was performed w/selective renal angiography demonstrating no reflux from ostium and very tight stenosis. 60-70 m gradient noted across the renal ostium. This was reproduced several times and renal pullback was performed to confirm level of stenosis. Following pressure pullback, cath was reengaged. At this point, decision was mdade to do PTA and stent of RRA. Cath was positioned inside proximal RRA, a spatacore wire was davanced into distal Renal arter. The cath was withdrawn leaving the spartacore wire positioned for support. Then 6 french shepherds crook guide was positioned at ostiym. Then balloon dilatition was performed utilizing 4mmx20 m long slalom balloon. This was used to predilate the lesion to nominal pressure up to 10 atmospheres. Based on Slalom ballooon, it was felt that renal artery was approx 7mm diameter artery at its origin. Dr selected 7mm diameterx15mm long Cordis blue renal artery stent. This was placed at ostium and great care was taken to make sure stnt covered ostium of the lesion, stent was deployed and taken up 10 atmospheres. Following deployment, balloon was deflated and pulled back into aorta. To make sure ostium was well expanded and dilated the balloon was taken up to 12 atmospheres and ostium was bermished. Angiography was repeated demonstrationg excellent results and no complications.
Do you code? 36245, 36252-59, 37236
