bhargavi
Guru
Conclusion
PROCEDURES
1. Abdominal aortogram
2. Bilateral lower extremity angiogram with runoff
3. Percutaneous intervention of bilateral CFA/SFA.
4. Manual pressure held at left brachial artery access.
PROCEDURE NOTE
Informed consent was obtained after explaining risks and benefits to the patient. Left brachial site was draped and prepped in the sterile fashion. Patient was premedicated with fentanyl and Versed. After injecting 2% lidocaine in the left brachial site, left brachial artery was accessed using micropuncture needle and a 6 French wide sheath was inserted without any difficulty. 5 French IM catheter was advanced and abdominal aortogram was performed. Bilateral lower extremity angiogram was performed. Patient was proceeded with intervention of the bilateral common femoral and superficial femoral arteries. Patient remained hemodynamically stable and tolerated procedure well. Patient was stable without any discomfort at the procedure.
ABDOMINAL AORTOGRAM
Abdominal aorta was patent without aneurysm or dilatation.
RIGHT LOWER EXTREMITY ANGIOGRAM
Common iliac artery was patent. Right external iliac artery was patent. Internal iliac was patent. Common femoral artery was diffusely diseased with moderate stenosis secondary from calcium. Superficial femoral artery was has 95% ostial stenosis secondary from extensive calcium, patent mid to distal segment. Popliteal artery was patent. Lower extremity runoff was not performed to avoid excessive IV dye exposure as well as radiation exposure.
LEFT LOWER EXTREMITY ANGIOGRAM
Common iliac artery was patent. Left external iliac artery was patent. Internal iliac was patent. Common femoral artery was severely diseased secondary from heavy calcification. Superficial femoral artery was severely diseased at the ostium secondary from heavy calcification with patent mid to distal segment. Popliteal artery was patent. Lower extremity runoff was not performed to avoid excessive IV dye and radiation exposure.
PERCUTANEOUS INTERVENTION OF
6 French 90 cm destination sheath was advanced over a Magic torque wire and the proximal end of the sheath was placed in the left common iliac artery. 4000 units of IV heparin was used for anticoagulation. Left CFA and SFA occlusion were successfully crossed using 300 cm Terumo Runthrough wire through a 0.018 Rubicon support catheter. Balloon angioplasty of CFA/SFA was performed using Sterling 6.0 x 100 mm balloon. Subsequent angiogram revealed significant improvement in the lesion of the left CFA and SFA artery without perforation or significant dissection and a brisk antegrade flow. Both lesions were again treated with 6.0 x 40 mm intravascular lithotripsy balloon with total treatment time of 120 seconds. These areas were further treated using Boston 6.0 x 40 mm cutting balloon. At this time run-through wire was exchanged for a 300 cm V 18 control wire. Further balloon angioplasty was performed using Mustang 8.0 x 40 mm balloon. This lesion was finally treated with Ranger 7.0 x 100 mm drug coated balloon. Final angiography revealed significant improvement in stenosis of CFA/SFA and TIMI III flow with brisk antegrade flow. ACT was measured at 160. Patient received another 4000 units of IV heparin.
Next, destination sheath was withdrawn into abdominal aorta above the bifurcation and redirected into right common iliac artery. Right CFA/SFA lesion was crossed using Terumo run-through wire through a 0.018 Rubicon catheter. Balloon angioplasty was performed using 7.0 x 100 mm previously used Ranger balloon. Run-through wire was exchanged for a V 18 control wire. Cutting Balloon angioplasty of CFA and SFA lesions were performed using Boston 6.0 x 20 mm cutting balloon. This area was further treated with Mustang 8.0 x 40 mm semicompliant balloon. Finally, Ranger 7.0 x 120 mm drug-coated balloon was used for final angioplasty. Final angiography revealed TIMI-3 flow without evidence of dissection or perforation. Final ACT was measured at 190. Patient was loaded with 600 mg of Plavix.
IMPRESSION
1. Severe bilateral common femoral and superficial femoral artery stenosis.
2. Status post force balloon angioplasty, Cutting Balloon angioplasty, intravascular lithotripsy, and drug-coated balloon angioplasty of bilateral CFA/SFA.
my question is should i bill 37224-50 (for bilateral) or per mue is 1 outpt so should i just bill 37224, C9764?
thank you for help in advance
PROCEDURES
1. Abdominal aortogram
2. Bilateral lower extremity angiogram with runoff
3. Percutaneous intervention of bilateral CFA/SFA.
4. Manual pressure held at left brachial artery access.
PROCEDURE NOTE
Informed consent was obtained after explaining risks and benefits to the patient. Left brachial site was draped and prepped in the sterile fashion. Patient was premedicated with fentanyl and Versed. After injecting 2% lidocaine in the left brachial site, left brachial artery was accessed using micropuncture needle and a 6 French wide sheath was inserted without any difficulty. 5 French IM catheter was advanced and abdominal aortogram was performed. Bilateral lower extremity angiogram was performed. Patient was proceeded with intervention of the bilateral common femoral and superficial femoral arteries. Patient remained hemodynamically stable and tolerated procedure well. Patient was stable without any discomfort at the procedure.
ABDOMINAL AORTOGRAM
Abdominal aorta was patent without aneurysm or dilatation.
RIGHT LOWER EXTREMITY ANGIOGRAM
Common iliac artery was patent. Right external iliac artery was patent. Internal iliac was patent. Common femoral artery was diffusely diseased with moderate stenosis secondary from calcium. Superficial femoral artery was has 95% ostial stenosis secondary from extensive calcium, patent mid to distal segment. Popliteal artery was patent. Lower extremity runoff was not performed to avoid excessive IV dye exposure as well as radiation exposure.
LEFT LOWER EXTREMITY ANGIOGRAM
Common iliac artery was patent. Left external iliac artery was patent. Internal iliac was patent. Common femoral artery was severely diseased secondary from heavy calcification. Superficial femoral artery was severely diseased at the ostium secondary from heavy calcification with patent mid to distal segment. Popliteal artery was patent. Lower extremity runoff was not performed to avoid excessive IV dye and radiation exposure.
PERCUTANEOUS INTERVENTION OF
6 French 90 cm destination sheath was advanced over a Magic torque wire and the proximal end of the sheath was placed in the left common iliac artery. 4000 units of IV heparin was used for anticoagulation. Left CFA and SFA occlusion were successfully crossed using 300 cm Terumo Runthrough wire through a 0.018 Rubicon support catheter. Balloon angioplasty of CFA/SFA was performed using Sterling 6.0 x 100 mm balloon. Subsequent angiogram revealed significant improvement in the lesion of the left CFA and SFA artery without perforation or significant dissection and a brisk antegrade flow. Both lesions were again treated with 6.0 x 40 mm intravascular lithotripsy balloon with total treatment time of 120 seconds. These areas were further treated using Boston 6.0 x 40 mm cutting balloon. At this time run-through wire was exchanged for a 300 cm V 18 control wire. Further balloon angioplasty was performed using Mustang 8.0 x 40 mm balloon. This lesion was finally treated with Ranger 7.0 x 100 mm drug coated balloon. Final angiography revealed significant improvement in stenosis of CFA/SFA and TIMI III flow with brisk antegrade flow. ACT was measured at 160. Patient received another 4000 units of IV heparin.
Next, destination sheath was withdrawn into abdominal aorta above the bifurcation and redirected into right common iliac artery. Right CFA/SFA lesion was crossed using Terumo run-through wire through a 0.018 Rubicon catheter. Balloon angioplasty was performed using 7.0 x 100 mm previously used Ranger balloon. Run-through wire was exchanged for a V 18 control wire. Cutting Balloon angioplasty of CFA and SFA lesions were performed using Boston 6.0 x 20 mm cutting balloon. This area was further treated with Mustang 8.0 x 40 mm semicompliant balloon. Finally, Ranger 7.0 x 120 mm drug-coated balloon was used for final angioplasty. Final angiography revealed TIMI-3 flow without evidence of dissection or perforation. Final ACT was measured at 190. Patient was loaded with 600 mg of Plavix.
IMPRESSION
1. Severe bilateral common femoral and superficial femoral artery stenosis.
2. Status post force balloon angioplasty, Cutting Balloon angioplasty, intravascular lithotripsy, and drug-coated balloon angioplasty of bilateral CFA/SFA.
my question is should i bill 37224-50 (for bilateral) or per mue is 1 outpt so should i just bill 37224, C9764?
thank you for help in advance