Wiki need help with peripheral 75716 or 75630?

bhargavi

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After obtaining informed consent, the patient was prepped and draped in the usual fashion. Approximately 10 mL 2% lidocaine anesthesia was administered to the right groin prior to placement of the arterial sheath. Under fluoroscopic guidance and using modified Seldinger technique a 5 French arterial sheath was placed without difficulty into the right femoral artery. We then obtained a 5 French contra catheter which was positioned in the distal abdominal aorta. We performed digital subtraction angiography of the abdominal aorta with bilateral iliofemoral runoff. This revealed a large and widely patent distal abdominal aorta as well as bilateral common, external, and internal iliac vessels to the level of the common femorals bilaterally.
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He then obtained a 180 cm 0.035 inch stiff angled zip wire which was utilized to advance the contra catheter to the level of the distal external iliac artery on the left. We then performed selective digital subtraction angiography of the left lower extremity. This revealed a patent common, superficial, and profundus femoris artery. Throughout the superficial femoral artery there was patchy disease of up to 20-30% severity. The most significant lesion was at the entry to the adductor canal, where there was an eccentric stenosis again of approximately 30-35% prior to the origin of the popliteal artery. The popliteal artery itself was patent throughout its proximal, middle, and distal segments with patchy 20-30% disease noted as well. Below the knee, the anterior tibial vessel was patent to the level of the ankle and across the ankle mortise with some 2 and fro flow through the ankle mortise without a significant stenosis identified. The tibioperoneal trunk was also patent. The posterior tibial artery was occluded in its early middle segment but reconstituted above the level of the ankle mortise. The peroneal vessel was diminutive but free of significant disease. Angiography of the left foot revealed some mild diffuse small vessel disease. There was no stenosis of significance in the inflow vessels, again only with occlusion of the posterior tibial vessel with reconstitution above the ankle mortise.
*
We then removed the contra catheter from the body and performed digital subtraction angiography of the right lower extremity through the 5 French arterial sheath. This again revealed a widely patent common, superficial, and profundus femoris artery. The superficial femoral artery again had patchy disease of up to 30% throughout its proximal and middle segments. The distal SFA was patent as was the popliteal throughout its proximal, middle, and distal segments. There was patchy 10-20% disease in the right popliteal vessel. Below the knee, the anterior tibial vessel was occluded proximally and reconstituted above the ankle mortise. The tibioperoneal trunk was widely patent with a large and widely patent posterior tibial and peroneal artery noted. Once again, there appeared to be mild to moderate diffuse small vessel disease and the foot. There were no significant inflow vessel lesions noted.
*
Nonselective injection of the right iliofemoral system revealed acceptable positioning of the arterial sheath above the common femoral bifurcation. There was no disease at the site of sheath insertion. As a result, the 5 French sheath was exchanged for a short 6 French sheath, after which a 6 French minx device was deployed for hemostasis. The patient was then transferred to the recovery area in stable condition.
*
Impression:
*
1. Mild bilateral SFA disease.
2. Occluded left posterior tibial vessel with reconstitution above the ankle.
3. Occluded right anterior tibial vessel with reconstitution above the ankle.
3. Good 2 vessel runoff below the knee bilaterally.
4. Status post makes placement
* I am thinking 75716
thank you in advance
 
After obtaining informed consent, the patient was prepped and draped in the usual fashion. Approximately 10 mL 2% lidocaine anesthesia was administered to the right groin prior to placement of the arterial sheath. Under fluoroscopic guidance and using modified Seldinger technique a 5 French arterial sheath was placed without difficulty into the right femoral artery. We then obtained a 5 French contra catheter which was positioned in the distal abdominal aorta. We performed digital subtraction angiography of the abdominal aorta with bilateral iliofemoral runoff. This revealed a large and widely patent distal abdominal aorta as well as bilateral common, external, and internal iliac vessels to the level of the common femorals bilaterally.
*
He then obtained a 180 cm 0.035 inch stiff angled zip wire which was utilized to advance the contra catheter to the level of the distal external iliac artery on the left. We then performed selective digital subtraction angiography of the left lower extremity. This revealed a patent common, superficial, and profundus femoris artery. Throughout the superficial femoral artery there was patchy disease of up to 20-30% severity. The most significant lesion was at the entry to the adductor canal, where there was an eccentric stenosis again of approximately 30-35% prior to the origin of the popliteal artery. The popliteal artery itself was patent throughout its proximal, middle, and distal segments with patchy 20-30% disease noted as well. Below the knee, the anterior tibial vessel was patent to the level of the ankle and across the ankle mortise with some 2 and fro flow through the ankle mortise without a significant stenosis identified. The tibioperoneal trunk was also patent. The posterior tibial artery was occluded in its early middle segment but reconstituted above the level of the ankle mortise. The peroneal vessel was diminutive but free of significant disease. Angiography of the left foot revealed some mild diffuse small vessel disease. There was no stenosis of significance in the inflow vessels, again only with occlusion of the posterior tibial vessel with reconstitution above the ankle mortise.
*
We then removed the contra catheter from the body and performed digital subtraction angiography of the right lower extremity through the 5 French arterial sheath. This again revealed a widely patent common, superficial, and profundus femoris artery. The superficial femoral artery again had patchy disease of up to 30% throughout its proximal and middle segments. The distal SFA was patent as was the popliteal throughout its proximal, middle, and distal segments. There was patchy 10-20% disease in the right popliteal vessel. Below the knee, the anterior tibial vessel was occluded proximally and reconstituted above the ankle mortise. The tibioperoneal trunk was widely patent with a large and widely patent posterior tibial and peroneal artery noted. Once again, there appeared to be mild to moderate diffuse small vessel disease and the foot. There were no significant inflow vessel lesions noted.
*
Nonselective injection of the right iliofemoral system revealed acceptable positioning of the arterial sheath above the common femoral bifurcation. There was no disease at the site of sheath insertion. As a result, the 5 French sheath was exchanged for a short 6 French sheath, after which a 6 French minx device was deployed for hemostasis. The patient was then transferred to the recovery area in stable condition.
*
Impression:
*
1. Mild bilateral SFA disease.
2. Occluded left posterior tibial vessel with reconstitution above the ankle.
3. Occluded right anterior tibial vessel with reconstitution above the ankle.
3. Good 2 vessel runoff below the knee bilaterally.
4. Status post makes placement
* I am thinking 75716
thank you in advance

I agree with the 75716, and add 36246 for the catheter placement.
HTH,
Jim Pawloski, CIRCC
 
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