Need help with procedure - renal artery angiography rpt with abdominal aortogram

Jane5711

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Renal artery angiography report with abdominal aortogram.


PROCEDURES PERFORMED:
1. Abdominal aortogram.
2. Selective bilateral renal artery angiography.
3. Angioplasty of the right renal artery with 4.5/20 mm balloon with
suboptimal angioplasty results.
4. Stenting of the right superior right renal artery with a 5.0/15 mm
Herculink Elite stent.
5. Angio-Seal of right femoral artery with 8 French Angio-Seal.

INDICATIONS:
1. Uncontrolled hypertension.
2. Renal insufficiency.
3. Severe 99 percent stenosis of the superior right renal artery.

DESCRIPTION OF THE PROCEDURE: 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.

Using a 5-French pigtail catheter, CO2 angiography of the abdominal aorta
was performed. Similarly then a 5-French pigtail catheter was removed and
the 5-French SOS catheter was used to selectively engage the left renal
artery and selective left renal artery angiography with the CO2 angiography
was performed followed by left renal artery angiography with conventional
contrast angiography was performed.

Then, using the same 5-French SOS catheter, right renal artery angiography
was performed. It was noted that there is only one right renal artery, the
inferior part of the right kidney appears to be completely occupied by large
cyst and appears to be nonfunctional. The 5-French SOS catheter was then
removed and then a 5-French arterial sheath was removed over a guidewire,
and a 6-French angiographic sheath was placed in the right femoral artery.

Using a 6-French hockey stick, guide was not optimal for engagement.


Then, a 6-French IMA guide was used to engage the right renal artery. A
0.014 Spartacore wire was used to cross the lesion in the proximal ostial
right renal artery. Then, a 4.5/20 mm balloon was used to dilate the lesion
at 12 atmospheres. The balloon was removed, but the angiographic results
are suboptimal. At this point, we tried to advance the stent, but the
entire _____ balloon catheter was too short for the guide.

There were _____ guides and hence the 6-French arterial sheath was removed
and a 6-French long Arrow sheath was used to see if they would engage the
right renal artery. This was not successful. Hence the entire stent was then
changed.

The guidewire from the renal artery was removed. Over a guidewire, a
7-French angiographic sheath was placed in the right femoral artery. A
7-French IMA guide was used to then reengage the right renal artery.

A 0.014 Spartacore wire was then used to cross the lesion in the ostial
proximal right renal artery. A 5.0/15 mm Herculink stent was advanced into
the ostial proximal right renal artery and was deployed at 14 atmospheres
with excellent results. The stent balloon was removed and angiographic
images were obtained. The guidewire and guiding catheter removed. Then,
7-French arterial sheath was removed over a guidewire and an 8-French
Angio-Seal was deployed in the right femoral artery successfully without any
complications. The patient was transferred in a stable condition with
complete hemostasis obtained without any complication to the floor for
further care.

RESULTS:
1. The abdominal aortogram shows mild diffuse atherosclerosis and
bifurcates into 2 iliac arteries.
2. Left renal artery: The left renal artery has 30 to 40 percent stenosis
in its proximal portion of _____ vessel with mild disease.
3. Right renal artery. There is a superior right renal artery and the
inferior part of the right kidney is not visualized because of being
completely occupied by cyst.
4. The right renal artery in its ostial proximal portion has 99 percent
stenosis.
5. After angioplasty of the right renal artery, there is still significant
residual stenosis of the proximal ostial right renal artery.

After the stenting of the right renal artery with a 5.0/15 mm Herculink
stent, there is 0 percent residual stenosis with no dissection, no
thrombosis and a distal flow excellent _____ with no cut off vessels.

FINAL RESULTS:
1. Prior to the procedure, there is a 99 percent stenosis of the ostial
proximal portion of the right renal artery.
2. Post-procedure after the angioplasty with suboptimal results of the
right renal artery and after stenting with a 5.0/15 mm Herculink Elite
stent, there is 0 percent residual stenosis with no dissection, no
thrombosis.
3. A 40 percent stenosis of the left renal artery noted.

PLAN: The patient will be monitored today with IV fluids and renal function
will be monitored tomorrow, _____ and maximum medical management of
hypertension to continue as before.

I'M NOT SURE HOW TO POST THE RENAL STENT
Looking forward to any help.
Thanks.
 

cpc2007

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The renal artery stent is coded with 37236 (this code is used for initial arterial stents other than intracranial, extracranial vertebral, cervical carotid, intrathoracic carotid, cardiac, coronary, and lower extremity arteries for occlusive disease as stents in these arteries all have their own code ranges). The bilateral renal angiogram is 36252. The radiology S&I for the renal angiogram, the aortogram and the work of selectively catheterizing the bilateral renal arteries/branches is all included in CPT 36252. Catheter placements are not included in CPT 37236 but because you are already being paid for catheter placements in the same arteries with the 36252, they should not be reported separately in this case. The angioplasty in the same vessel (right renal artery) is included in the stent placement code.

So your final codes are 37236 and 36252. I hope that helps :).
 
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