Perc angioplasty 37226 37221

nlbarnes

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Location
Escondido, CA
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To much? I tried to eliminate the codes that were included in 37224 but...

36012 - ?
37226
37221
76937-26-59
75710-26-59

PROCEDURES:
1. Ultrasound-guided percutaneous access of right common femoral
artery.
2. Aortogram with left lower extremity runoff.
3. Percutaneous transluminal angioplasty and stenting of left
superficial femoral artery with a 5 mm x 200 mm angioplasty
balloon followed by a 5 mm x 120 mm Supera self-expanding stent.
4. Percutaneous transluminal angioplasty and stenting of left common
iliac artery with an 8 mm x 27 mm balloon expandable stent.
5. Completion angiography.
6. Supervision and interpretation of the above.

DESCRIPTION OF PROCEDURE:
Ultrasound was used to percutaneously access the right common femoral artery after which a
guidewire and sheath were placed in the vessel without difficulty. An
Omni Flush catheter was then placed at the aortic bifurcation after
which an aortogram was performed as described above. A combination of
Omni Flush catheter and stiff-angled Glidewire were used to traverse
the aortic bifurcation after which a 6-French Balkin sheath was
tracked to the left common femoral artery without difficulty. The
patient was systemically heparinized with 7000 units of intravenous
heparin. At this time, a combination of a stiff-angled Glidewire and
a Kumpe catheter along with 0.018 V-18 wire were used to engage the
orifice of the occluded left superficial femoral artery at its origin.
The superficial femoral artery was occluded from its origin and
reconstituted in the above knee popliteal location through geniculate
and profunda collaterals. A combination of a stiff-angled Glidewire
and a seeker catheter were then used to traverse the occluded SFA and
re-enter luminally in the popliteal artery. V-18 wire was then placed
distally into the peroneal artery without difficulty. Initially, a 5
mm x 200 mm angioplasty balloon was used to angioplasty the entire
course of the occluded SFA, after which a completion angiogram
revealed persistent residual stenosis in the midportion. At this
time, a 5 mm x 120 mm Supera self-expanding stent was deployed across
this area without complication. Completion angiogram revealed widely
patent SFA. At this time, a wire was attempted to track down the
occluded posterior tibial artery. However, this was not able to pass
down to the level of plantar artery. There was a widely patent
anterior tibial artery, which was patent to the foot. At this time,
then the sheath was pulled back and the angiogram of the left common
iliac was performed which revealed a greater than 50% stenosis of the
mid portion of the common iliac artery. At this time, an 8 mm x 27 mm
balloon expandable stent was deployed across this lesion without
difficulty. Completion angiogram revealed no residual stenosis and
resolution of the stenosis itself.
 

RJROBER

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To much? I tried to eliminate the codes that were included in 37224 but...

36012 - ?
37226
37221
76937-26-59
75710-26-59

PROCEDURES:
1. Ultrasound-guided percutaneous access of right common femoral
artery.
2. Aortogram with left lower extremity runoff.
3. Percutaneous transluminal angioplasty and stenting of left
superficial femoral artery with a 5 mm x 200 mm angioplasty
balloon followed by a 5 mm x 120 mm Supera self-expanding stent.
4. Percutaneous transluminal angioplasty and stenting of left common
iliac artery with an 8 mm x 27 mm balloon expandable stent.
5. Completion angiography.
6. Supervision and interpretation of the above.

DESCRIPTION OF PROCEDURE:
Ultrasound was used to percutaneously access the right common femoral artery after which a
guidewire and sheath were placed in the vessel without difficulty. An
Omni Flush catheter was then placed at the aortic bifurcation after
which an aortogram was performed as described above. A combination of
Omni Flush catheter and stiff-angled Glidewire were used to traverse
the aortic bifurcation after which a 6-French Balkin sheath was
tracked to the left common femoral artery without difficulty. The
patient was systemically heparinized with 7000 units of intravenous
heparin. At this time, a combination of a stiff-angled Glidewire and
a Kumpe catheter along with 0.018 V-18 wire were used to engage the
orifice of the occluded left superficial femoral artery at its origin.
The superficial femoral artery was occluded from its origin and
reconstituted in the above knee popliteal location through geniculate
and profunda collaterals. A combination of a stiff-angled Glidewire
and a seeker catheter were then used to traverse the occluded SFA and
re-enter luminally in the popliteal artery. V-18 wire was then placed
distally into the peroneal artery without difficulty. Initially, a 5
mm x 200 mm angioplasty balloon was used to angioplasty the entire
course of the occluded SFA, after which a completion angiogram
revealed persistent residual stenosis in the midportion. At this
time, a 5 mm x 120 mm Supera self-expanding stent was deployed across
this area without complication. Completion angiogram revealed widely
patent SFA. At this time, a wire was attempted to track down the
occluded posterior tibial artery. However, this was not able to pass
down to the level of plantar artery. There was a widely patent
anterior tibial artery, which was patent to the foot. At this time,
then the sheath was pulled back and the angiogram of the left common
iliac was performed which revealed a greater than 50% stenosis of the
mid portion of the common iliac artery. At this time, an 8 mm x 27 mm
balloon expandable stent was deployed across this lesion without
difficulty. Completion angiogram revealed no residual stenosis and
resolution of the stenosis itself.

I would only bill 37226 and 37221. Cath placement codes (for the same extremity as the intervention) and imaging related to guidance are non-billable. You could possibly bill 75710 if it was truly diagnostic and medically necessary, but in this case it does not sound like it was. It sounds like all imaging was related to the intervention. You could also possibly bill 76937 if the US was stored and vessel patency is mentioned in the findings.

Ryan Roberts, CPC, CIRCC, CANPC
 

Jim Pawloski

True Blue
Messages
1,386
Location
Ann Arbor
Best answers
1
To much? I tried to eliminate the codes that were included in 37224 but...

36012 - ?
37226
37221
76937-26-59
75710-26-59

PROCEDURES:
1. Ultrasound-guided percutaneous access of right common femoral
artery.
2. Aortogram with left lower extremity runoff.
3. Percutaneous transluminal angioplasty and stenting of left
superficial femoral artery with a 5 mm x 200 mm angioplasty
balloon followed by a 5 mm x 120 mm Supera self-expanding stent.
4. Percutaneous transluminal angioplasty and stenting of left common
iliac artery with an 8 mm x 27 mm balloon expandable stent.
5. Completion angiography.
6. Supervision and interpretation of the above.

DESCRIPTION OF PROCEDURE:
Ultrasound was used to percutaneously access the right common femoral artery after which a
guidewire and sheath were placed in the vessel without difficulty. An
Omni Flush catheter was then placed at the aortic bifurcation after
which an aortogram was performed as described above. A combination of
Omni Flush catheter and stiff-angled Glidewire were used to traverse
the aortic bifurcation after which a 6-French Balkin sheath was
tracked to the left common femoral artery without difficulty. The
patient was systemically heparinized with 7000 units of intravenous
heparin. At this time, a combination of a stiff-angled Glidewire and
a Kumpe catheter along with 0.018 V-18 wire were used to engage the
orifice of the occluded left superficial femoral artery at its origin.
The superficial femoral artery was occluded from its origin and
reconstituted in the above knee popliteal location through geniculate
and profunda collaterals. A combination of a stiff-angled Glidewire
and a seeker catheter were then used to traverse the occluded SFA and
re-enter luminally in the popliteal artery. V-18 wire was then placed
distally into the peroneal artery without difficulty. Initially, a 5
mm x 200 mm angioplasty balloon was used to angioplasty the entire
course of the occluded SFA, after which a completion angiogram
revealed persistent residual stenosis in the midportion. At this
time, a 5 mm x 120 mm Supera self-expanding stent was deployed across
this area without complication. Completion angiogram revealed widely
patent SFA. At this time, a wire was attempted to track down the
occluded posterior tibial artery. However, this was not able to pass
down to the level of plantar artery. There was a widely patent
anterior tibial artery, which was patent to the foot. At this time,
then the sheath was pulled back and the angiogram of the left common
iliac was performed which revealed a greater than 50% stenosis of the
mid portion of the common iliac artery. At this time, an 8 mm x 27 mm
balloon expandable stent was deployed across this lesion without
difficulty. Completion angiogram revealed no residual stenosis and
resolution of the stenosis itself.

Also, 36012 is a venous code, and you are in the arterial side. But it really didn't matter since this was an intervention and catheter codes are bundled in the lower extremity intervention.

Jim Pawloski, CIRCC
 
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