Tenicajo
Contributor
Hello,
I have a provider who wants to bill up to 15 units of IVUS per date of service. MUE=5 and MAI=3. Is this doable?
See below for brief excerpt of OP note
Findings
Diffuse stenosis of the right superficial femoral artery. Below the knee, there is two vessel runoff via anterior tibial and peroneal arteries.
Posterior tibial artery is occluded. Post procedure, there is improved flow throughout the arterial tree. Anterior tibial artery is the dominant
vessel. DP signal biphasic, PT and peroneal monophasic.
IVUS findings: Mild to moderate disease in the bilateral external and common iliac arteries. Diffuse moderate disease in the right superficial
femoral artery and popliteal artery with a patent common femoral artery with mild disease. There is severe diffuse disease of the right
anterior tibial artery as well as the peroneal artery. Moderate to severe disease in the right lateral tarsal artery. The left common femoral
artery is patent. After balloon angioplasty of the right superficial femoral artery, there was noted to be a severe flow-limiting dissection in the
mid right superficial femoral artery for which a stent was placed and subsequent intravascular ultrasound demonstrated resolution of the
dissection with excellent flow through that midportion of the right superficial femoral artery.
Subsequently intravascular ultrasound was performed of the right superficial femoral artery, the
right popliteal artery, the right anterior tibial artery, the right dorsalis pedis artery, and the right lateral tarsal artery with the findings
described above.
Subsequent intravascular sound was performed of the right popliteal artery, the right tibial
peroneal trunk, the right peroneal artery, and the right posterior tibial artery. Subsequently after measurement with intravascular ultrasound
a 4 mm drug-coated balloon was used to perform angioplasty of the right tibioperoneal trunk and subsequently a 5 mm drug-coated balloon
was used to perform angioplasty of the right popliteal artery. Subsequently the sheath was pulled back and intravascular ultrasound was
performed of the right popliteal artery the right superficial femoral artery which was diffusely diseased as well as the right common femoral
artery the right external iliac artery.
Intravascular ultrasound was performed in order to determine the precise extent of the disease in the affected vessels, as well as to assess
all vessels treated after angioplasty, and/or atherectomy and stenting. Additionally it was performed in order to determine if there was any
dissection after the treatment was performed. It was also used to measure the exact size of all affected and treated vessels in order to
determine the correct size of balloon and or stent to be placed. Finally, it was used to determine the exact and precise location of the lesion
to ensure that each lesion was adequately treated prior to completion of the procedure. Intraoperative decisions were made based on the
results of the intravascular ultrasound examination in order to optimize the treatment of this patient. A recording of all intravascular
ultrasound images was made. Please see findings from the intravascular ultrasound above.
I have a provider who wants to bill up to 15 units of IVUS per date of service. MUE=5 and MAI=3. Is this doable?
See below for brief excerpt of OP note
Findings
Diffuse stenosis of the right superficial femoral artery. Below the knee, there is two vessel runoff via anterior tibial and peroneal arteries.
Posterior tibial artery is occluded. Post procedure, there is improved flow throughout the arterial tree. Anterior tibial artery is the dominant
vessel. DP signal biphasic, PT and peroneal monophasic.
IVUS findings: Mild to moderate disease in the bilateral external and common iliac arteries. Diffuse moderate disease in the right superficial
femoral artery and popliteal artery with a patent common femoral artery with mild disease. There is severe diffuse disease of the right
anterior tibial artery as well as the peroneal artery. Moderate to severe disease in the right lateral tarsal artery. The left common femoral
artery is patent. After balloon angioplasty of the right superficial femoral artery, there was noted to be a severe flow-limiting dissection in the
mid right superficial femoral artery for which a stent was placed and subsequent intravascular ultrasound demonstrated resolution of the
dissection with excellent flow through that midportion of the right superficial femoral artery.
Subsequently intravascular ultrasound was performed of the right superficial femoral artery, the
right popliteal artery, the right anterior tibial artery, the right dorsalis pedis artery, and the right lateral tarsal artery with the findings
described above.
Subsequent intravascular sound was performed of the right popliteal artery, the right tibial
peroneal trunk, the right peroneal artery, and the right posterior tibial artery. Subsequently after measurement with intravascular ultrasound
a 4 mm drug-coated balloon was used to perform angioplasty of the right tibioperoneal trunk and subsequently a 5 mm drug-coated balloon
was used to perform angioplasty of the right popliteal artery. Subsequently the sheath was pulled back and intravascular ultrasound was
performed of the right popliteal artery the right superficial femoral artery which was diffusely diseased as well as the right common femoral
artery the right external iliac artery.
Intravascular ultrasound was performed in order to determine the precise extent of the disease in the affected vessels, as well as to assess
all vessels treated after angioplasty, and/or atherectomy and stenting. Additionally it was performed in order to determine if there was any
dissection after the treatment was performed. It was also used to measure the exact size of all affected and treated vessels in order to
determine the correct size of balloon and or stent to be placed. Finally, it was used to determine the exact and precise location of the lesion
to ensure that each lesion was adequately treated prior to completion of the procedure. Intraoperative decisions were made based on the
results of the intravascular ultrasound examination in order to optimize the treatment of this patient. A recording of all intravascular
ultrasound images was made. Please see findings from the intravascular ultrasound above.