Need help with coding

Jane5711

Networker
Messages
67
Location
Port Charlotte, Florida
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0
Can anyone help with coding the following:

1. Mid abdominal aortogram
2. Bilateral lower extremity arterial angiography with runoff.
3. Selective bilateral renal artery angiography x2
4. Selective unilaterial left renal artery angiography
5. Left superficial femoral artery and selective angiography
6. Left superficial femoral artery angioplasty with a 6.0/60mm absolute pro self-expanding stent, post dilated with 6.0mm balloon
7. Left anterior tibial artery angioplasty x3. Stents include 2.5/24mm promus stent in the distal portion, 2.5/38mm promus stent in the mid distal portion and 3.0/15 mm promus stent in the proximal mid portion of the left anterior tibial artery.

I come up with
75625
36252
37226
37230

I need an experienced coder as I'm new to this.
Thanks for your help in advance.
 
Messages
24
Best answers
0
access

HI Jane

Hard to accurately help you without a procedure description. Access point is important in lower extremity vascular work and history to know if intention is diagnostic turned intervention etc.

can you give more of that record?
 

Jane5711

Networker
Messages
67
Location
Port Charlotte, Florida
Best answers
0
Procedure Report

Hi,
Thank you so much for responding. Here is the procedure report:
Procedure performed:
1. Mid abdominal aortogram
2. Bilateral lower extremity arterial angiography with runoff.
3. Selective bilateral renal artery angiography x2
4. Selective unilaterial left renal artery angiography
5. Left superficial femoral artery and selective angiography
6. Left superficial femoral artery angioplasty with a 6.0/60mm absolute pro self-expanding stent, post dilated with 6.0mm balloon
7. Left anterior tibial artery angioplasty x3. Stents include 2.5/24mm promus stent in the distal portion, 2.5/38mm promus stent in the mid distal portion and 3.0/15 mm promus stent in the proximal mid portion of the left anterior tibial artery.

Procedure: After the informed consent was obtained, the patient was prepped and drapped in the usual sterile fashion. Liodcaine 2 percent was used for anesthesia in the right groin. Vascular access was obtained in the right femoral artery. Over a guidewire, a 6-french arterial sheath was entered into the right femoral artery.

Over a guidewire, a 5-french pigtail catheter was introduced in the mid abdominal aorta and mid abdominal aortogram was performed.

A 5-french pigtail catheter was withdrawn to the level of the distal abdominal aorta and bilateral lower extremity angiography with runoff was performed.

Using a 5-french UF catheter, a guidewire was introduced into the left external iliac artery. Over this UF catheter was advanced into the mid portion of the left external iliac artery.

Prior to this, the 6-french arterial sheath had been removed and 6-french long Terumo sheath was advanced ____ UF catheter appeared. Then over the UF catheter, the 6-french Termuo sheath was advanced into the left external iliac artery.

The UF catheter was then removed.

Through the existing UF catheter, 0.035 Glidewire was used to try to cross the lesion through the completely occluded left common femoral artery.

Attempting to cross the lesion was not successful.

Hence, the guidewire was removed, the pigtail catheter was removed and angiography of the left common iliac artery and external iliac artery angiography was performed.

Then over the guidewire, a 5-french IMA catheter was used to engage the left renal artery and selective left renal artery angiography was performed.

A 5-French IMA catheter was used to selectively engage the superior right renal artery and superior right renal artery angiography selectively was performed.

IMA catheter was then used to selectively engage inferior right renal artery, inferior right renal artery angiography selectively was performed.

Then, using the sheath in the right external iliac artery a the angiography of the right common femoral artery and subsequently right thigh arteries were performed. At the end of the case, the arterial sheath was removed, and hemostasis was obtained with the application of manual pressure and hemostatic patch. The patient was transferred in a stable condition to the floor for further care with no complications.

I come up with
75625
36252
37226
37230

I'm new at this so I'm not quite sure. Thanks!
 

Jim Pawloski

True Blue
Messages
1,389
Location
Ann Arbor
Best answers
1
Hi,
Thank you so much for responding. Here is the procedure report:
Procedure performed:
1. Mid abdominal aortogram
2. Bilateral lower extremity arterial angiography with runoff.
3. Selective bilateral renal artery angiography x2
4. Selective unilaterial left renal artery angiography
5. Left superficial femoral artery and selective angiography
6. Left superficial femoral artery angioplasty with a 6.0/60mm absolute pro self-expanding stent, post dilated with 6.0mm balloon
7. Left anterior tibial artery angioplasty x3. Stents include 2.5/24mm promus stent in the distal portion, 2.5/38mm promus stent in the mid distal portion and 3.0/15 mm promus stent in the proximal mid portion of the left anterior tibial artery.

Procedure: After the informed consent was obtained, the patient was prepped and drapped in the usual sterile fashion. Liodcaine 2 percent was used for anesthesia in the right groin. Vascular access was obtained in the right femoral artery. Over a guidewire, a 6-french arterial sheath was entered into the right femoral artery.

Over a guidewire, a 5-french pigtail catheter was introduced in the mid abdominal aorta and mid abdominal aortogram was performed.

A 5-french pigtail catheter was withdrawn to the level of the distal abdominal aorta and bilateral lower extremity angiography with runoff was performed.

Using a 5-french UF catheter, a guidewire was introduced into the left external iliac artery. Over this UF catheter was advanced into the mid portion of the left external iliac artery.

Prior to this, the 6-french arterial sheath had been removed and 6-french long Terumo sheath was advanced ____ UF catheter appeared. Then over the UF catheter, the 6-french Termuo sheath was advanced into the left external iliac artery.

The UF catheter was then removed.

Through the existing UF catheter, 0.035 Glidewire was used to try to cross the lesion through the completely occluded left common femoral artery.

Attempting to cross the lesion was not successful.

Hence, the guidewire was removed, the pigtail catheter was removed and angiography of the left common iliac artery and external iliac artery angiography was performed.

Then over the guidewire, a 5-french IMA catheter was used to engage the left renal artery and selective left renal artery angiography was performed.

A 5-French IMA catheter was used to selectively engage the superior right renal artery and superior right renal artery angiography selectively was performed.

IMA catheter was then used to selectively engage inferior right renal artery, inferior right renal artery angiography selectively was performed.

Then, using the sheath in the right external iliac artery a the angiography of the right common femoral artery and subsequently right thigh arteries were performed. At the end of the case, the arterial sheath was removed, and hemostasis was obtained with the application of manual pressure and hemostatic patch. The patient was transferred in a stable condition to the floor for further care with no complications.

I come up with
75625
36252
37226
37230

I'm new at this so I'm not quite sure. Thanks!

Thanks for the report. I have a major question on this report. The doc states that he could not get through the occluded common femoral artery occlusion, so how can he state numbers 5,6,and 7 in his procedures list. I would agree with only 36252 and 36245-XS, 75716-59. No Intervention.
HTH,
Jim Pawloski, R.T.(CV), CIRCC
 

Jane5711

Networker
Messages
67
Location
Port Charlotte, Florida
Best answers
0
Need help with coding -correct procedure report

Hi Jim,
Hope this makes more sense as to coding. I posted the wrong procedure report -):

PROCEDURES PERFORMED:
1. Mid abdominal aortogram.
2. Bilateral lower extremity arterial angiography with runoff.
3. Selective bilateral renal artery angiography x2.
4. Selective unilateral left renal artery angiography.
5. Left superficial femoral artery and selective angiography.
6. Left superficial femoral artery angioplasty with a 6.0/60 mm Absolute
Pro self-expanding stent, post-dilated with a 6.0 mm balloon.
7. Left superficial femoral artery angioplasty with 6.0/60 mm balloon.
8. Left anterior tibial artery angioplasty x3.
9. Left anterior tibial artery stent x3. Stents include 2.5/24 mm Promus
stent in the distal portion, 2.5/38 mm Promus stent in the mid distal
portion and 3.0/15 mm Promus stent in the proximal mid portion of the
left anterior tibial artery.

INDICATIONS:
1. Nonhealing ulcer of the left great toe.
2. Severe peripheral artery disease with monophasic flow waveform in the
left lower extremity.
3. High-grade lesions are suspected in the mid portion of the left
superficial femoral artery and left anterior tibial artery, diffusely
diseased.
4. Peripheral artery disease.
5. Uncontrolled hypertension with renal artery atherosclerosis.

PROCEDURE IN DETAIL: After the informed consent was obtained, the patient
was prepped and draped in the usual sterile fashion. Lidocaine 2 percent
was used for local anesthesia in the right groin. Vascular access was
obtained in the right femoral artery, and over a guidewire, a 5-French
angiographic sheath was placed in the right femoral artery.

A 5-French pigtail catheter was introduced over a guidewire into the mid
abdominal aorta and mid abdominal aortogram angiography was performed.

Then, over a guidewire, the 5-French arterial sheath was removed and a
6-French long crossover arrow sheath was advanced over the guidewire and



with the help of a 5-French universal flush catheter, the crossover sheath
and a 5-French universal flush catheter was advanced in the left lower
extremity arteries including positioning the universal flush catheter into
the left superficial femoral artery and the crossover sheath into the left
common femoral artery.

Then, selective angiography of the left superficial femoral artery was
performed through the 5-French universal flush catheter to visualize the
left superficial femoral artery and left popliteal artery and trifurcation
arteries below the knee.

A 5-French universal flush catheter was then removed.

With the help of a Quick-Cross catheter and a 0.014 Command wire, the
lesions in the distal portion of the left anterior tibial artery were
crossed.

A 2.5/40 mm balloon was advanced over a guidewire into the distal left
anterior tibial artery and was used to do the dilatation of the distal
anterior tibial artery at 10 atmospheres. Balloon was then withdrawn more
proximally and was used to dilate the lesion of somewhat more proximal in
the distal left anterior tibial artery. Balloon was then used to
angioplasty the proximal portion of the left anterior tibial artery.

When the angiography was obtained, the left anterior tibial artery had
suboptimal angioplasty results in the proximal, mid, and mid distal portion
and distal portion despite angioplasty.

Hence, it was decided to stent this lesions.

Hence, a 2.5/38 mm Promus Premier Everolimus drug-eluting stent was advanced
into the distal anterior tibial artery above the ankle joint. The stent was
deployed at 14 atmospheres with good results. The stent balloon was then
advanced further distally and used for further dilation of the very distal
left anterior tibial artery.

The stent balloon was then removed.

Further attempts to advance the stents in the left anterior tibial artery
with different stents were not successful.

Hence, the setup was changed. The Command wire was removed and over a
guidewire, the 6-French arrow sheath was removed and then 73 cm long sheath
was advanced over a Glidewire into the mid portion of the mid portion of the
left superficial femoral artery.

Then, the Command wire with the help of the Quick-Cross catheter was again
used to cross the lesion in the distal left anterior tibial artery.

Then, a 2.5/24 mm Promus Premier Everolimus drug-eluting stent was advanced
into the very distal left anterior tibial artery crossing through the
previously placed stent and near the ankle joint and the stent was deployed



at 14 atmospheres with good results. Stent balloon was then removed.

Then, over the Command wire, a 3.0/16 mm Promus Premier Everolimus
drug-eluting stent was advanced into the proximal mid portion of the left
anterior tibial artery and was deployed at 16 atmospheres with good results.
The stent balloon was then removed.

Then, attention was given to the left superficial femoral artery lesions.

Then, a 6.0/60 mm balloon was used to dilate the lesion in the mid portion
of the left superficial femoral artery with the partially successful results
with suboptimal angioplasty results.

Then, hence a 6.0/60 mm Absolute Pro stent was advanced into the mid portion
of the left superficial femoral artery and was deployed.

Then, through the stent, 6.0/60 mm balloon was used to dilate the stent,
post-dilatation was performed. The balloon was then removed and final
angiographic images were obtained.

Then, the crossover sheath was removed up to the right iliac artery and then
over a guidewire, it was removed and a 6-French short angiographic sheath
was placed in the right femoral artery.

Through this sheath, over a guidewire, a 5-French IMA catheter was
introduced and then used to selectively engage the superior left renal
artery. The superior left renal artery angiography was performed.

Then, the superior right renal artery angiography was performed by _____ the
superior right renal artery.

Then, a 6-French IMA catheter was used to engage the inferior left renal
artery, inferior left renal artery angiography was performed.

Then, the IMA catheter was removed and over a guidewire, the short arterial
sheath was removed, and after angiography, the right femoral artery
angiography was performed.

At this point, over a guidewire, a 6-French Angio-Seal was deployed in the
right femoral artery successfully and then complete image was obtained
successfully without any complications. The patient was transferred in
stable condition to the floor for further care with no complications.

FINDINGS:
1. The distal mid abdominal aorta has mild diffuse atherosclerosis. It
bifurcates into both 2 common iliac arteries bilaterally.
2. Common iliac arteries: Both right and left common iliac arteries have
mild disease and bifurcate into external and internal iliac arteries
bilaterally.
3. Internal iliac arteries: Both right and left internal iliac arteries
have moderate diffuse disease.
4. External iliac arteries: Both right and left external iliac arteries



have mild disease without any high-grade focal stenosis and continues on
as a common femoral artery.
5. Common femoral arteries:
a. Right common femoral artery: The right common femoral artery has
ulcerative 50 percent stenosis just before its bifurcation into deep and
superficial femoral arteries.
b. Left common femoral artery: Left common femoral artery has mild
without any high-grade focal stenosis and bifurcates into superficial
femoral and then deep femoral arteries.
6. Deep femoral arteries: Both right and left deep femoral arteries
mild disease without any high-grade focal stenosis.
7. Superficial femoral arteries:
a. Right superficial femoral artery: Right superficial femoral
mild disease without any high-grade focal stenosis and continues on as a
right popliteal artery.
b. Left superficial femoral artery: Left superficial femoral artery
medium-caliber vessel in its mid distal and its mid portion, it is
ulcerated, 80 percent stenosis with calcification. It continues on as a
left popliteal artery.
8. Left popliteal arteries: Right and left popliteal arteries have
disease without any high-grade focal stenosis and continue on as
trifurcation arteries bilaterally.
9. Trifurcation arteries: The right anterior tibial artery and right
peroneal trunk arise normally from the popliteal arteries.
10. The right peroneal trunk bifurcates into the right peroneal
the right posterior tibial artery.

The right anterior tibial artery, right posterior tibial artery and right
peroneal artery have mild diffuse disease and there is a 3-vessel runoff to
the ankle.

Left trifurcation arteries: The left anterior tibial artery and left common
peroneal artery arise from up left popliteal arteries.

Left anterior tibial artery: Left anterior tibial artery has a 95 percent
stenosis in its proximal portion.

The mid portion of the left anterior tibial artery has 80 percent diffuse
stenosis.

Distal portion of the left anterior tibial artery just slightly above the
ankle has a 99 percent subtotal occlusion with the 2 branches running
supplied by collaterals into the left foot.

Left common peroneal trunk: The left common peroneal trunk gives rise to
left posterior tibial and left peroneal artery.

Both left peroneal artery and left posterior tibial artery have diminutive
vessels, small vessel, less than 1 mm caliber vessel and seem to be occluded
in the mid calf.

Thus, there is one-vessel runoff to the left foot.




RENAL ARTERY ANGIOGRAPHY:

LEFT RENAL ARTERY: There are 2 left renal arteries.

Superior left renal artery has mild disease with up to 30-40 percent
proximal stenosis. The rest of the vessel with mild disease.

INFERIOR LEFT RENAL ARTERY: Inferior left renal artery has 80 percent
proximal stenosis, is a small vessel supplying the inferior pole of the left
kidney.

RIGHT RENAL ARTERY: The right renal artery is a moderate-caliber vessel
with up to 30 percent stenosis in its proximal portion. There appears to be
another inferior right renal artery, which was not visualized. The rest of
the right superior renal artery has no high-grade focal stenosis.

FINAL RESULTS: Prior to the procedure, there was an 80 percent calcific
stenosis of the mid portion of the left superficial femoral artery.

Post-procedure, after angioplasty result with suboptimal results and
stenting with a 6.0/60 mm Absolute Pro stent, there is 0 percent residual
stenosis within this lesion with no dissection, no thrombosis, and distal
flow which is excellent.

Prior to the procedure, there was a 95 percent stenosis of the proximal
portion of the left anterior tibial artery and 80 percent stenosis of the
mid distal portion of the left anterior tibial artery as well as 99 percent
subtotal occlusion with collateral of the mid distal portion of the left
anterior tibial artery near the ankle with reconstitution into 2
sub-branches distally beyond the subtotal occlusion.

Post-procedure, after angioplasty of the left anterior tibial artery in the
proximal portion, mid portion and mid and distal portion, and distal
portion, there is suboptimal angioplasty results, but after the stenting of
the proximal portion of the left anterior tibial artery with a 3.0/16 mm
Promus stent, stenting of the mid distal left anterior tibial artery with a
2.5/38 mm Promus stent and a very distal left anterior tibial artery with a
2.5/24 mm Promus stent, there is 0 percent residual stenosis within this
lesion with no dissection, no thrombosis and excellent flow. There is
moderate disease still present in the midportion of the left anterior tibial
artery, which is to be treated me:confused:dically.

PLAN:
1. The patient will be kept on aspirin and clopidogrel for 1 month and then
switched to clopidogrel alone and discontinue aspirin because the
patient will needs to be restarted on Xarelto with a previous history of
paroxysmal atrial fibrillation.
2. The patients medical management of peripheral vascular disease and
hypercholesteremia; continue as before.

Many thanks for anyones help!
 

Jim Pawloski

True Blue
Messages
1,389
Location
Ann Arbor
Best answers
1
Hi Jim,
Hope this makes more sense as to coding. I posted the wrong procedure report -):

PROCEDURES PERFORMED:
1. Mid abdominal aortogram.
2. Bilateral lower extremity arterial angiography with runoff.
3. Selective bilateral renal artery angiography x2.
4. Selective unilateral left renal artery angiography.
5. Left superficial femoral artery and selective angiography.
6. Left superficial femoral artery angioplasty with a 6.0/60 mm Absolute
Pro self-expanding stent, post-dilated with a 6.0 mm balloon.
7. Left superficial femoral artery angioplasty with 6.0/60 mm balloon.
8. Left anterior tibial artery angioplasty x3.
9. Left anterior tibial artery stent x3. Stents include 2.5/24 mm Promus
stent in the distal portion, 2.5/38 mm Promus stent in the mid distal
portion and 3.0/15 mm Promus stent in the proximal mid portion of the
left anterior tibial artery.

INDICATIONS:
1. Nonhealing ulcer of the left great toe.
2. Severe peripheral artery disease with monophasic flow waveform in the
left lower extremity.
3. High-grade lesions are suspected in the mid portion of the left
superficial femoral artery and left anterior tibial artery, diffusely
diseased.
4. Peripheral artery disease.
5. Uncontrolled hypertension with renal artery atherosclerosis.

PROCEDURE IN DETAIL: After the informed consent was obtained, the patient
was prepped and draped in the usual sterile fashion. Lidocaine 2 percent
was used for local anesthesia in the right groin. Vascular access was
obtained in the right femoral artery, and over a guidewire, a 5-French
angiographic sheath was placed in the right femoral artery.

A 5-French pigtail catheter was introduced over a guidewire into the mid
abdominal aorta and mid abdominal aortogram angiography was performed.

Then, over a guidewire, the 5-French arterial sheath was removed and a
6-French long crossover arrow sheath was advanced over the guidewire and



with the help of a 5-French universal flush catheter, the crossover sheath
and a 5-French universal flush catheter was advanced in the left lower
extremity arteries including positioning the universal flush catheter into
the left superficial femoral artery and the crossover sheath into the left
common femoral artery.

Then, selective angiography of the left superficial femoral artery was
performed through the 5-French universal flush catheter to visualize the
left superficial femoral artery and left popliteal artery and trifurcation
arteries below the knee.

A 5-French universal flush catheter was then removed.

With the help of a Quick-Cross catheter and a 0.014 Command wire, the
lesions in the distal portion of the left anterior tibial artery were
crossed.

A 2.5/40 mm balloon was advanced over a guidewire into the distal left
anterior tibial artery and was used to do the dilatation of the distal
anterior tibial artery at 10 atmospheres. Balloon was then withdrawn more
proximally and was used to dilate the lesion of somewhat more proximal in
the distal left anterior tibial artery. Balloon was then used to
angioplasty the proximal portion of the left anterior tibial artery.

When the angiography was obtained, the left anterior tibial artery had
suboptimal angioplasty results in the proximal, mid, and mid distal portion
and distal portion despite angioplasty.

Hence, it was decided to stent this lesions.

Hence, a 2.5/38 mm Promus Premier Everolimus drug-eluting stent was advanced
into the distal anterior tibial artery above the ankle joint. The stent was
deployed at 14 atmospheres with good results. The stent balloon was then
advanced further distally and used for further dilation of the very distal
left anterior tibial artery.

The stent balloon was then removed.

Further attempts to advance the stents in the left anterior tibial artery
with different stents were not successful.

Hence, the setup was changed. The Command wire was removed and over a
guidewire, the 6-French arrow sheath was removed and then 73 cm long sheath
was advanced over a Glidewire into the mid portion of the mid portion of the
left superficial femoral artery.

Then, the Command wire with the help of the Quick-Cross catheter was again
used to cross the lesion in the distal left anterior tibial artery.

Then, a 2.5/24 mm Promus Premier Everolimus drug-eluting stent was advanced
into the very distal left anterior tibial artery crossing through the
previously placed stent and near the ankle joint and the stent was deployed



at 14 atmospheres with good results. Stent balloon was then removed.

Then, over the Command wire, a 3.0/16 mm Promus Premier Everolimus
drug-eluting stent was advanced into the proximal mid portion of the left
anterior tibial artery and was deployed at 16 atmospheres with good results.
The stent balloon was then removed.

Then, attention was given to the left superficial femoral artery lesions.

Then, a 6.0/60 mm balloon was used to dilate the lesion in the mid portion
of the left superficial femoral artery with the partially successful results
with suboptimal angioplasty results.

Then, hence a 6.0/60 mm Absolute Pro stent was advanced into the mid portion
of the left superficial femoral artery and was deployed.

Then, through the stent, 6.0/60 mm balloon was used to dilate the stent,
post-dilatation was performed. The balloon was then removed and final
angiographic images were obtained.

Then, the crossover sheath was removed up to the right iliac artery and then
over a guidewire, it was removed and a 6-French short angiographic sheath
was placed in the right femoral artery.

Through this sheath, over a guidewire, a 5-French IMA catheter was
introduced and then used to selectively engage the superior left renal
artery. The superior left renal artery angiography was performed.

Then, the superior right renal artery angiography was performed by _____ the
superior right renal artery.

Then, a 6-French IMA catheter was used to engage the inferior left renal
artery, inferior left renal artery angiography was performed.

Then, the IMA catheter was removed and over a guidewire, the short arterial
sheath was removed, and after angiography, the right femoral artery
angiography was performed.

At this point, over a guidewire, a 6-French Angio-Seal was deployed in the
right femoral artery successfully and then complete image was obtained
successfully without any complications. The patient was transferred in
stable condition to the floor for further care with no complications.

FINDINGS:
1. The distal mid abdominal aorta has mild diffuse atherosclerosis. It
bifurcates into both 2 common iliac arteries bilaterally.
2. Common iliac arteries: Both right and left common iliac arteries have
mild disease and bifurcate into external and internal iliac arteries
bilaterally.
3. Internal iliac arteries: Both right and left internal iliac arteries
have moderate diffuse disease.
4. External iliac arteries: Both right and left external iliac arteries



have mild disease without any high-grade focal stenosis and continues on
as a common femoral artery.
5. Common femoral arteries:
a. Right common femoral artery: The right common femoral artery has
ulcerative 50 percent stenosis just before its bifurcation into deep and
superficial femoral arteries.
b. Left common femoral artery: Left common femoral artery has mild
without any high-grade focal stenosis and bifurcates into superficial
femoral and then deep femoral arteries.
6. Deep femoral arteries: Both right and left deep femoral arteries
mild disease without any high-grade focal stenosis.
7. Superficial femoral arteries:
a. Right superficial femoral artery: Right superficial femoral
mild disease without any high-grade focal stenosis and continues on as a
right popliteal artery.
b. Left superficial femoral artery: Left superficial femoral artery
medium-caliber vessel in its mid distal and its mid portion, it is
ulcerated, 80 percent stenosis with calcification. It continues on as a
left popliteal artery.
8. Left popliteal arteries: Right and left popliteal arteries have
disease without any high-grade focal stenosis and continue on as
trifurcation arteries bilaterally.
9. Trifurcation arteries: The right anterior tibial artery and right
peroneal trunk arise normally from the popliteal arteries.
10. The right peroneal trunk bifurcates into the right peroneal
the right posterior tibial artery.

The right anterior tibial artery, right posterior tibial artery and right
peroneal artery have mild diffuse disease and there is a 3-vessel runoff to
the ankle.

Left trifurcation arteries: The left anterior tibial artery and left common
peroneal artery arise from up left popliteal arteries.

Left anterior tibial artery: Left anterior tibial artery has a 95 percent
stenosis in its proximal portion.

The mid portion of the left anterior tibial artery has 80 percent diffuse
stenosis.

Distal portion of the left anterior tibial artery just slightly above the
ankle has a 99 percent subtotal occlusion with the 2 branches running
supplied by collaterals into the left foot.

Left common peroneal trunk: The left common peroneal trunk gives rise to
left posterior tibial and left peroneal artery.

Both left peroneal artery and left posterior tibial artery have diminutive
vessels, small vessel, less than 1 mm caliber vessel and seem to be occluded
in the mid calf.

Thus, there is one-vessel runoff to the left foot.




RENAL ARTERY ANGIOGRAPHY:

LEFT RENAL ARTERY: There are 2 left renal arteries.

Superior left renal artery has mild disease with up to 30-40 percent
proximal stenosis. The rest of the vessel with mild disease.

INFERIOR LEFT RENAL ARTERY: Inferior left renal artery has 80 percent
proximal stenosis, is a small vessel supplying the inferior pole of the left
kidney.

RIGHT RENAL ARTERY: The right renal artery is a moderate-caliber vessel
with up to 30 percent stenosis in its proximal portion. There appears to be
another inferior right renal artery, which was not visualized. The rest of
the right superior renal artery has no high-grade focal stenosis.

FINAL RESULTS: Prior to the procedure, there was an 80 percent calcific
stenosis of the mid portion of the left superficial femoral artery.

Post-procedure, after angioplasty result with suboptimal results and
stenting with a 6.0/60 mm Absolute Pro stent, there is 0 percent residual
stenosis within this lesion with no dissection, no thrombosis, and distal
flow which is excellent.

Prior to the procedure, there was a 95 percent stenosis of the proximal
portion of the left anterior tibial artery and 80 percent stenosis of the
mid distal portion of the left anterior tibial artery as well as 99 percent
subtotal occlusion with collateral of the mid distal portion of the left
anterior tibial artery near the ankle with reconstitution into 2
sub-branches distally beyond the subtotal occlusion.

Post-procedure, after angioplasty of the left anterior tibial artery in the
proximal portion, mid portion and mid and distal portion, and distal
portion, there is suboptimal angioplasty results, but after the stenting of
the proximal portion of the left anterior tibial artery with a 3.0/16 mm
Promus stent, stenting of the mid distal left anterior tibial artery with a
2.5/38 mm Promus stent and a very distal left anterior tibial artery with a
2.5/24 mm Promus stent, there is 0 percent residual stenosis within this
lesion with no dissection, no thrombosis and excellent flow. There is
moderate disease still present in the midportion of the left anterior tibial
artery, which is to be treated me:confused:dically.

PLAN:
1. The patient will be kept on aspirin and clopidogrel for 1 month and then
switched to clopidogrel alone and discontinue aspirin because the
patient will needs to be restarted on Xarelto with a previous history of
paroxysmal atrial fibrillation.
2. The patients medical management of peripheral vascular disease and
hypercholesteremia; continue as before.

Many thanks for anyones help!

OK, for this one I would code 37230-LT, 37226-LT, 75716-59,36252-XS
Thanks for the interesting case!
Jim Pawloski, CIRCC
 
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