Peripheral coding

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Indications: Severe intermittent claudication

HPI: 49 year old w/history of significant coronary artery disease w/previous percutaneous intervention as well as significant symtomatic claudication, peripheral artery disease. He is a chronic smoker. He has been maximized on therapy and has been encouraged to ambulate in light of his claudication symptoms.He was previously trialed on medical therapy w/Pletal, however, he is not currently taking. He underwent lower extremity arterial Doppler ultrasound that demonstrated high-grade disease, left grater than the right which suggests occlusion of his left SFA w/his symptoms of claudication occurring after only 50 to 100 feet of ambulation. He was referred for selective angiography to better qualify and characterize his disease w/an eye towards intervention if applicable.

Procedure detail: Right common femoral artery was accessed using modified Seldinger technique of which a 6 French 11 cm sheath was placed without complication. Diagnostic catheter was a Contra catheter.

Procedures Performed: Bilateral iliofemoral lower extremity angiography, selective SFA sequential stenting, right iliac angiography and Angio-Seal deployment w/supervision and interpretation.

Findings: Bilateral iliofemoral angiography was performed that demonstrated mild disease at the aortoiliac junction. The left common iliac had mild disease. The deep profunda had mild disease on the left side. The left SFA had sequential 80% lesion seen in the midvessel segment. This expanded approximately 50 mm. The left popliteal was with mild disease. The peroneal trunk had good 3-vessel runoff. The right common iliac had mild disease and right external iliac had mild disease. The right common femoral artery had mild disease. With appropriate placement the arteriotomy site was felt suitable for percutaneous closure.

Summary: High-grade left SFA lesion coordinating with the patient's refractory symptoms and ultrasound imaging. With these findings, it was decided to proceed w/angioplasty.

Intervention: Angiomax was used for effective anticoagulation and the 6 French sheath was exchanged for a 6 French 90 cm Terumo guide sheath. The sheath was placed into the proximal portion of the left SFA and a Wholey wire was placed to the distal popliteal. A 6.0x60 Fox plus balloon was inflated to 8 atmospheres for ballon angioplasty. A subsequent injection showed a resultant dissection and a suboptimal imaging result. As such, a 6.0X30 bare-metal stent was placed and in an overlapping fashion and a 6.0x29 mm stent was placed with an excellent angiographic result and good distal runoff. There was no evidence of cutoff and good 3-vessel runoff post-procedure.

Summary: Successful balloon angioplasy w/subsequent stenting of the left SFA w/two bare-metal stent.

Coding:
36140-59
36247-59
75736-26-59
75716-59
37224-59
37226
Would this be the correct coding? Thanks Nancy
 

jewlz0879

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Drop the cath placements (36140, 36247) since 37226 includes all cath placements. I would drop 75736. I would keep 75716-26,59 (following guidelines set forth on pg. 373 of CPT). I would also drop 37224 since that is included with 37226.

37226
75716-26,59

HTH

HTH
 

dpeoples

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Birmingham, Alabama
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Drop the cath placements (36140, 36247) since 37226 includes all cath placements. I would drop 75736. I would keep 75716-26,59 (following guidelines set forth on pg. 373 of CPT). I would also drop 37224 since that is included with 37226.

37226
75716-26,59

HTH

HTH
I agree with Julie. The peripheral intervention codes (except iliac atherectomy) are now inclusive of all catheter placements/acess. I do not see an selective pelvic angiography so I would not code 75736.

HTH :)
 
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