vidraj
Guru
Hello everyone,
I need help with this procedure described below:
Indication: Patient referred for bilateral leg ulcerations. The patient was suspected to have bilateral venous insufficiency; however, an ABI was done as a screening test, which was abnormal and hence suggested bilateral SFA stenosis and hence the patient was brought in for further angiography and intervention.
TECHNIQUE: Under aseptic precautions, conscious sedation, the right radial artery was accessed via Seldinger technique, 6-French sheath was introduced. A 5-French long pigtail was parked in the distal aorta and abdominal aortic angiography and bilateral lower extremity angiography was performed. This was followed by advancing a 150 length Cook glide catheter positioned and common femoral arteries bilaterally sequentially and lower extremity angiography was performed to the ankle level6. Intervention followed and detailed below.
Findings of diagnostic angiography are as follows:
- Abdominal aorta was patent. The bifurcation was patent.
- The right lower extremity angiography showed the right common iliac artery to be patent, right external iliac artery to be patent, right CFA to be patent, right superficial femoral artery to have a proximal focal 90% stenosis. Additional 90b stenosis in the distal right SFA noted. Read of the right popliteal artery and infra popliteal vessels all the way to the ankle were widely patent.
- The left side angiography. Findings showed left common iliac artery to be patent, left external iliac artery to be patent, left CFA and the proximal SFA to be patent all the way to the adductor canal. Upon reaching the rectal canal proximal part had a 99% critical stenosis followed by complete occlusion of the SFA in the adductor canal and reconstitution via dense collaterals filling up the popliteal artery via the popliteal branches filling up retrogradely to found the common popliteal trunk as well as the distal popliteal artery filling up via dense genicular collateral arteries. Rest of the infra popliteal vessels showed patent posterior tibial artery all the way to the ankle level and anterior tibial artery probably tapered off in the middle since it could not be visualized at the ankle level.
Intervention followed:
The 6-French sheath was exchanged over a stiff Glide wire to a 6-French Destination sheath,65 cm with the tip of the sheath parked in the left mid SFA via right groin access. . the lesion was then attempted directly with a paclitaxel-coated balloon, inflated to 6 atmospheres and 6tayed occluded for 2-1/2 minutes with significant improvement of stenosis with residual stenosis being less than 10t with excellent results. Significant improvement in the Quality of flow for the collaterals was noted post-procedure without any compromise. Intra-arterial Cardizem was used. The patient remained stable.
1.37224 - LT - I73.9, R94.30, I87.2 (intervention was through Right groin access)
2. 36246 - 50, 59 - I73.9, R94.30, I87.2 (Abd angio + Bil LE Angio was through Radial access - hope I can code this separately as the port of access if different)
3. 75716 - 26, 59 - I73.9, R94.30, I87.2
4. 75625 - 26 - I73.9, R94.30, I87.2
or is this coded as the 37224 and 75630 only?
Can anyone suggest?
TIA.
I need help with this procedure described below:
Indication: Patient referred for bilateral leg ulcerations. The patient was suspected to have bilateral venous insufficiency; however, an ABI was done as a screening test, which was abnormal and hence suggested bilateral SFA stenosis and hence the patient was brought in for further angiography and intervention.
TECHNIQUE: Under aseptic precautions, conscious sedation, the right radial artery was accessed via Seldinger technique, 6-French sheath was introduced. A 5-French long pigtail was parked in the distal aorta and abdominal aortic angiography and bilateral lower extremity angiography was performed. This was followed by advancing a 150 length Cook glide catheter positioned and common femoral arteries bilaterally sequentially and lower extremity angiography was performed to the ankle level6. Intervention followed and detailed below.
Findings of diagnostic angiography are as follows:
- Abdominal aorta was patent. The bifurcation was patent.
- The right lower extremity angiography showed the right common iliac artery to be patent, right external iliac artery to be patent, right CFA to be patent, right superficial femoral artery to have a proximal focal 90% stenosis. Additional 90b stenosis in the distal right SFA noted. Read of the right popliteal artery and infra popliteal vessels all the way to the ankle were widely patent.
- The left side angiography. Findings showed left common iliac artery to be patent, left external iliac artery to be patent, left CFA and the proximal SFA to be patent all the way to the adductor canal. Upon reaching the rectal canal proximal part had a 99% critical stenosis followed by complete occlusion of the SFA in the adductor canal and reconstitution via dense collaterals filling up the popliteal artery via the popliteal branches filling up retrogradely to found the common popliteal trunk as well as the distal popliteal artery filling up via dense genicular collateral arteries. Rest of the infra popliteal vessels showed patent posterior tibial artery all the way to the ankle level and anterior tibial artery probably tapered off in the middle since it could not be visualized at the ankle level.
Intervention followed:
The 6-French sheath was exchanged over a stiff Glide wire to a 6-French Destination sheath,65 cm with the tip of the sheath parked in the left mid SFA via right groin access. . the lesion was then attempted directly with a paclitaxel-coated balloon, inflated to 6 atmospheres and 6tayed occluded for 2-1/2 minutes with significant improvement of stenosis with residual stenosis being less than 10t with excellent results. Significant improvement in the Quality of flow for the collaterals was noted post-procedure without any compromise. Intra-arterial Cardizem was used. The patient remained stable.
1.37224 - LT - I73.9, R94.30, I87.2 (intervention was through Right groin access)
2. 36246 - 50, 59 - I73.9, R94.30, I87.2 (Abd angio + Bil LE Angio was through Radial access - hope I can code this separately as the port of access if different)
3. 75716 - 26, 59 - I73.9, R94.30, I87.2
4. 75625 - 26 - I73.9, R94.30, I87.2
or is this coded as the 37224 and 75630 only?
Can anyone suggest?
TIA.