New to vascular coding; help with descriptions

NM36

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"...the left arm was prepped and draped in the usual manner, especially just above the antecubital fossa. The left brachial artery just above the antecubital fossa was sonographically evaluated and determined to be patent. Real-time ultrasound was used to visualize needle intry in to the vessel and a permanent image was stored. A micropuncture access kit was used to access this vessel. Then, a 6-french 65 cm Raabe sheath was inserted. The wire was advanced into the aorta and down into the abdominal aorta and the sheath was advanced over that. A distal aortogram was performed which showed severe stenosis in the bilateral external iliac arteries as well as the left common femoral artery leading into the existing fem-pop bypass graft...... A long angled glidewire was advanced down across the area of stenosis and into the common femoral artery on the right. the long area of stenosis was then stented using a 6 mm x 80 mm self-expanding stent. It was postdilated with a 5 mm x 8mm balloon. An excellent result was obtained with no residual stenosis. The exact same thing was done to the right external iliac artery using the same size stent and balloon. The The area of focal left common femoral artery stenosis leading into the graft was then treated with a 5 mm x 20 mm balloon. An excellent result was obtained there as well...."

Can I use 75630 for the aortogram as described?
then; 37226_RT and 37221_LT ??

(the doctor noted 37221_50, but I didn't think that would be correct, as he stented CFA on the right, and iliac on the left)

Any help appreciated! :)

Nancy
 

Jim Pawloski

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"...the left arm was prepped and draped in the usual manner, especially just above the antecubital fossa. The left brachial artery just above the antecubital fossa was sonographically evaluated and determined to be patent. Real-time ultrasound was used to visualize needle intry in to the vessel and a permanent image was stored. A micropuncture access kit was used to access this vessel. Then, a 6-french 65 cm Raabe sheath was inserted. The wire was advanced into the aorta and down into the abdominal aorta and the sheath was advanced over that. A distal aortogram was performed which showed severe stenosis in the bilateral external iliac arteries as well as the left common femoral artery leading into the existing fem-pop bypass graft...... A long angled glidewire was advanced down across the area of stenosis and into the common femoral artery on the right. the long area of stenosis was then stented using a 6 mm x 80 mm self-expanding stent. It was postdilated with a 5 mm x 8mm balloon. An excellent result was obtained with no residual stenosis. The exact same thing was done to the right external iliac artery using the same size stent and balloon. The The area of focal left common femoral artery stenosis leading into the graft was then treated with a 5 mm x 20 mm balloon. An excellent result was obtained there as well...."

Can I use 75630 for the aortogram as described?
then; 37226_RT and 37221_LT ??

(the doctor noted 37221_50, but I didn't think that would be correct, as he stented CFA on the right, and iliac on the left)

Any help appreciated! :)

Nancy
Question that I have is, on the right side, is that one long lesion or two separate stenosis? If they are not ( and by doctor's comment, I think it's one lesion) you code 37221-50. For the aortogram, yes code 75630-59 for that.
HTH,
Jim Pawloski, CIRCC
 
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