Please help coding this scenario:
PROCEDURES PERFORMED:
1. Abdominal aortogram with bilateral lower extremity runoff.
2. Carotid arteriogram, selective.
3. Laser atherectomy followed by percutaneous transluminal angioplasty
of the left superficial femoral artery.
CLINICAL SUMMARY: The patient is a pleasant 68-year-old white female
who presented with symptoms of claudication bilaterally. Lately she has
experienced episodes of dizziness and spells, which required her to be
hospitalized at one time.
PROTOCOL: The patient was brought to the cath lab. Both groins were
prepped and draped in the usual sterile fashion. Xylocaine was
infiltrated for right femoral artery access with a single stick and a 5-
French sheath inserted. A 5-French OmniFlush catheter was advanced and
an abdominal angiogram was performed followed by runoff using 80 mL of
contrast, as well as chase method. No complications occurred.
FINDINGS:
ABDOMINAL AORTOGRAM: The abdominal aorta shows good caliber with mild
atherosclerosis. Bilateral and multiple renal arteries are patent but
showing moderate disease. Mesenteric artery shows proximal disease with
calcification and may be of interest, if patient has symptoms of
postprandial abdominal symptoms. However, the severity of this lesion
was not carefully assessed. The bifurcation is intact with no
significant disease involving the bifurcation.
RIGHT LOWER EXTREMITY ARTERIOGRAM: The right circulation reveals the
following: The right common iliac artery has a 60 to 70% narrowing at
the very proximal part, which is showing evidence of ulceration. The
right common iliac leads up to patent external and internal iliac
arteries. The extremely big artery shows heavy disease up to 50%
severity leading up to the bifuraction and the profunda and superficial
femoral artery. The superficial femoral artery in the proximal third
shows very severe disease up to 90 to 95% severity. The middle and
distal third of the superficial femoral artery reveals moderate-heavy
disease with up to 60 to 70% lesions and multiple 60% lesions in
multiple places leading up to the popliteal artery, which is patent and
leads to the trifucation. The trifurcation reveals moderate disease
with patency of all three vessels of the anterior tibial, posterior
tibial and peroneal arteries are patent with three-vessel runoff to the
distal leg.
LEFT LOWER EXTREMITY ARTERIOGRAM: The left circulation reveals the
following: The left common iliac artery shows mild to moderate
atherosclerosis diffusely but large caliber with at least external iliac
artery, which shows 50 to 60% heavy plaque with eccentric and tortuous
vessel leading to bifurcation. The superficial femoral artery reveals
aggressive severe disease extending from the proximal part all the way
to the popliteal with up to 90% stenosis in 2 or 3 spots. The popliteal
artery is relatively free of any disease and leads up to a trifucation,
which is showing patent anterior tibial, posterior tibial and peroneal
vessels with flow into the foot without any significant disease.
I think it should be coded as followed:
1. 36245, 75630-26 - Abdominal aortogram with bilateral lower extremity runoff.
2. 36216 - Carotid arteriogram, selective.
3. 37225 - Laser atherectomy followed by percutaneous transluminal angioplasty
of the left superficial femoral artery.
I may be way off but would really appreciate your help!
PROCEDURES PERFORMED:
1. Abdominal aortogram with bilateral lower extremity runoff.
2. Carotid arteriogram, selective.
3. Laser atherectomy followed by percutaneous transluminal angioplasty
of the left superficial femoral artery.
CLINICAL SUMMARY: The patient is a pleasant 68-year-old white female
who presented with symptoms of claudication bilaterally. Lately she has
experienced episodes of dizziness and spells, which required her to be
hospitalized at one time.
PROTOCOL: The patient was brought to the cath lab. Both groins were
prepped and draped in the usual sterile fashion. Xylocaine was
infiltrated for right femoral artery access with a single stick and a 5-
French sheath inserted. A 5-French OmniFlush catheter was advanced and
an abdominal angiogram was performed followed by runoff using 80 mL of
contrast, as well as chase method. No complications occurred.
FINDINGS:
ABDOMINAL AORTOGRAM: The abdominal aorta shows good caliber with mild
atherosclerosis. Bilateral and multiple renal arteries are patent but
showing moderate disease. Mesenteric artery shows proximal disease with
calcification and may be of interest, if patient has symptoms of
postprandial abdominal symptoms. However, the severity of this lesion
was not carefully assessed. The bifurcation is intact with no
significant disease involving the bifurcation.
RIGHT LOWER EXTREMITY ARTERIOGRAM: The right circulation reveals the
following: The right common iliac artery has a 60 to 70% narrowing at
the very proximal part, which is showing evidence of ulceration. The
right common iliac leads up to patent external and internal iliac
arteries. The extremely big artery shows heavy disease up to 50%
severity leading up to the bifuraction and the profunda and superficial
femoral artery. The superficial femoral artery in the proximal third
shows very severe disease up to 90 to 95% severity. The middle and
distal third of the superficial femoral artery reveals moderate-heavy
disease with up to 60 to 70% lesions and multiple 60% lesions in
multiple places leading up to the popliteal artery, which is patent and
leads to the trifucation. The trifurcation reveals moderate disease
with patency of all three vessels of the anterior tibial, posterior
tibial and peroneal arteries are patent with three-vessel runoff to the
distal leg.
LEFT LOWER EXTREMITY ARTERIOGRAM: The left circulation reveals the
following: The left common iliac artery shows mild to moderate
atherosclerosis diffusely but large caliber with at least external iliac
artery, which shows 50 to 60% heavy plaque with eccentric and tortuous
vessel leading to bifurcation. The superficial femoral artery reveals
aggressive severe disease extending from the proximal part all the way
to the popliteal with up to 90% stenosis in 2 or 3 spots. The popliteal
artery is relatively free of any disease and leads up to a trifucation,
which is showing patent anterior tibial, posterior tibial and peroneal
vessels with flow into the foot without any significant disease.
I think it should be coded as followed:
1. 36245, 75630-26 - Abdominal aortogram with bilateral lower extremity runoff.
2. 36216 - Carotid arteriogram, selective.
3. 37225 - Laser atherectomy followed by percutaneous transluminal angioplasty
of the left superficial femoral artery.
I may be way off but would really appreciate your help!