Medicare Patient denial 37216,52 PLEASE HELP!!

Tullahoma, TN
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PROCEDURE PERFORMED: Attempted, but aborted right internal carotid artery

PREOPERATIVE DIAGNOSIS: Severe, symptomatic right carotid stenosis.

DESCRIPTION OF PROCEDURE: The patient was brought to the cath lab and
prepped and draped in the usual sterile fashion. The right femoral artery
was accessed using Seldinger technique. A 5-French sheath was inserted and a
sheath angiogram was obtained. Next, I exchanged for a 6-French shuttle
sheath with a V-tach catheter. The right carotid artery was cannulated, but
a guide wire could not be advanced. I then switched to a _____ wire, which
kept repeatedly prolapsing. A stiff Glidewire was attempted again, again
without success. At this juncture, the V-tach catheter and the 6-French
shuttle sheath were removed. Within a short 6-French sheath and use a
Simmons 2 catheter, the right carotid artery was repeatedly cannulated, but
no wire could be advanced without repeated prolapsing. At this juncture
after several catheters and wires, I felt that the aortic arch was not
friendly to sheath delivery and aborted further attempts. The femoral sheath
was removed and hemostasis was achieved with deployment of a Mynx closure


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PTA of the carotid without stent placement is not covered by Medicare.

I have not experienced and attempted(aborted) stent placement that has resulted in PTA only. therefore I am not knowledgeable is this can be overturned

NCD 20.7