My physician did the following Peripheral Intervention. I am overwhelmed and would appreciate help in coding this. If you know of any good reference materials, so that I can learn how to code these, I would appreciate any information you can give me. Thank you.
Female complaining of severe lifestyle limiting claudication, in fact pain at rest of her right toe. Her foot is dusky.Admitted for diagnostic angiogram and possible intervention.
Procedure: Included access of bilateral femoral arteries.Lower abdominal aortogram with single vessel runoff included kissing stent to the lower abdominal aorta into the iliac arteries to make a new carina, included further stenting of the right common to the external iliac artery in 2 separate spots for severe stenosis.Bilateral Angio-Seal device was utilized as well.Bilateral 7-French sheath and finally a French Brite Tip was utilized in both groins.There was a 99% stenosis in the proximal external iliac artery. A further 75% stenosis just proximal to the previous stent and as stated 99% to perhaps 100% occlusion of the right common iliac artery.The procedure included crossing of the severe total occlusion eventually with a V18 wire.After the V18 wire criss-cross- NaviCross would not cross into the aorta secondary to severe stenosis. We then proceeded to dilate with a 2.0 and finally a 4.0 mm balloon, at which poin we were able to gain access into the true aorta with the criss-cross. The V18 wire was exchanged for Advantage wire and a second Advantage wire was placed via the left groin into the central aorta as well. Thereafter, kissing iCAST stents were placed under fluoroscopic guidance, a7x59 mm in the right iliac and a 7x38 mm in the left iliac producing a new carina. Thereafter a 6x22 mm stent was placed in the right distal common to proximal external iliac for a 75% stenosis and a 6x38 was then placed in the very proximal right external iliac artery for a 99% stenosis. This stent was post-dilated with a 6mm balloon. Thereafter, the left external iliac artery was anticoagulated with heparin with additional doses as needed. Final angiograms revealed brisk flow bilaterally into both iliac arteries down to the femoral arteries. There were palpable pulses in her right posterior tibial and dorsalis pedis areas, which were absent prior o the stenting. Bilateral 8-French Angio-Seals were administered without complications. The patient tolerated the procedure well. Conscious sedation was obtained with fentanyl and Versed.
Female complaining of severe lifestyle limiting claudication, in fact pain at rest of her right toe. Her foot is dusky.Admitted for diagnostic angiogram and possible intervention.
Procedure: Included access of bilateral femoral arteries.Lower abdominal aortogram with single vessel runoff included kissing stent to the lower abdominal aorta into the iliac arteries to make a new carina, included further stenting of the right common to the external iliac artery in 2 separate spots for severe stenosis.Bilateral Angio-Seal device was utilized as well.Bilateral 7-French sheath and finally a French Brite Tip was utilized in both groins.There was a 99% stenosis in the proximal external iliac artery. A further 75% stenosis just proximal to the previous stent and as stated 99% to perhaps 100% occlusion of the right common iliac artery.The procedure included crossing of the severe total occlusion eventually with a V18 wire.After the V18 wire criss-cross- NaviCross would not cross into the aorta secondary to severe stenosis. We then proceeded to dilate with a 2.0 and finally a 4.0 mm balloon, at which poin we were able to gain access into the true aorta with the criss-cross. The V18 wire was exchanged for Advantage wire and a second Advantage wire was placed via the left groin into the central aorta as well. Thereafter, kissing iCAST stents were placed under fluoroscopic guidance, a7x59 mm in the right iliac and a 7x38 mm in the left iliac producing a new carina. Thereafter a 6x22 mm stent was placed in the right distal common to proximal external iliac for a 75% stenosis and a 6x38 was then placed in the very proximal right external iliac artery for a 99% stenosis. This stent was post-dilated with a 6mm balloon. Thereafter, the left external iliac artery was anticoagulated with heparin with additional doses as needed. Final angiograms revealed brisk flow bilaterally into both iliac arteries down to the femoral arteries. There were palpable pulses in her right posterior tibial and dorsalis pedis areas, which were absent prior o the stenting. Bilateral 8-French Angio-Seals were administered without complications. The patient tolerated the procedure well. Conscious sedation was obtained with fentanyl and Versed.