Wiki peripheral intervention

[jdmjine]

37229 and 75716 I'll be using these codes but is this all I have for this procedure? need some help, thanks

An antegrade micropuncture sheath was inserted directly into the common femoral artery and into the superficial femoral artery. 5-French 35 cm Cordis Brite tip sheath was advanced into the mid SFA. IV heparin was given for anticoagulation. Right Lower Extremity angiogram was performed. A v18 wire was taken over a 0.018 cm straigh tip CXI catheter. The V18 wire was able to be advanced into the anterior tibial artery. The wire was then changed out for a Treasure 12 wire, which was able to be advanced w/ careful manipulation, passed the entire mid SFA, mid anterior tibial artery occlusion and into the widely patent dorsalis pedis artery in the foot. Over this wire, the catheters could not be passed. The CXI catheter could not be advanced over this to change wire out. New CXI catheter was taken.An 0.018 2 X 20mm balloon was taken and was also unable to be advanced over the wire into the distal vessel. At this point, with CXI catheter buried into the tip of the plaque as far as it could go. The treasure 12 wire was removed and 0.014 PT2 moderate support wire was taken and was able to be advancedthrough the same channel w/0 difficulty into the dorsalis pedis artery. Subsequently, it was decided to perform laser atherectomy with 0.9mm Spectranetics laser catheter. The laser catheter was taken and was advanced into the distal popliteal artery aith contrast flushed out of the vessel and saline continuously flushed during laser atherectomy. The catheter was slowly advanced from the distal politeal artery all the way into the proximal anterior tibial artery and into the mid vessel. There was a point of resistance in the mid vessel, which was able to be traversed with an increased pulse rate to 40 and a fluency of 45. Subsequently in the distal anterior tibial artery above the ankle, the laser catheter could not be passed despite a fluency set at 50 and pulse rate set at 50. At this point the catheter was removed and a 2.0x220 cm Bard 0.018 wire balloon was taken over the PT2 moderate support wire w/o difficulty. Balloon angioplasty was performed from the ankle all the way up into the distal popliteal artery with 2 separate inflations at roughly 2 min. each at 12 atmospheres. The balloon expanded w/o waste.Follow-up angiogram showed uninterrupted in-line flow through the anterior tibial artery, however, there was still scattered areas of severe stenosis, which was then treated with a balloon angioplasty using a 3X300cm balloon for 2 min inflation at 12 atmospheres. Follow-up angiogram showed widely patent anterior tibial artery with scattered areas of moderate narrowing, but no high-grade stenosis. There was a brisk antegrade flow into the dorsalis pedis artery at the ankle and foot. There is no evidence of dissection. There was some residual minimal filling defect in the distal popliteal artery and extending into the peroneal artery, but brisk antegrade flow. The distal popliteal artery eccentric stenosis also appeared to be reduced to roughly 50%. At this point, the wire was removed. Attention was then turned to the left lower extremity. Limited angiogram was performed.

 

[theresa.dix@tennova.com]

37229 and 75716 I'll be using these codes but is this all I have for this procedure? need some help, thanks

An antegrade micropuncture sheath was inserted directly into the common femoral artery and into the superficial femoral artery. 5-French 35 cm Cordis Brite tip sheath was advanced into the mid SFA. IV heparin was given for anticoagulation. Right Lower Extremity angiogram was performed. A v18 wire was taken over a 0.018 cm straigh tip CXI catheter. The V18 wire was able to be advanced into the anterior tibial artery. The wire was then changed out for a Treasure 12 wire, which was able to be advanced w/ careful manipulation, passed the entire mid SFA, mid anterior tibial artery occlusion and into the widely patent dorsalis pedis artery in the foot. Over this wire, the catheters could not be passed. The CXI catheter could not be advanced over this to change wire out. New CXI catheter was taken.An 0.018 2 X 20mm balloon was taken and was also unable to be advanced over the wire into the distal vessel. At this point, with CXI catheter buried into the tip of the plaque as far as it could go. The treasure 12 wire was removed and 0.014 PT2 moderate support wire was taken and was able to be advancedthrough the same channel w/0 difficulty into the dorsalis pedis artery. Subsequently, it was decided to perform laser atherectomy with 0.9mm Spectranetics laser catheter. The laser catheter was taken and was advanced into the distal popliteal artery aith contrast flushed out of the vessel and saline continuously flushed during laser atherectomy. The catheter was slowly advanced from the distal politeal artery all the way into the proximal anterior tibial artery and into the mid vessel. There was a point of resistance in the mid vessel, which was able to be traversed with an increased pulse rate to 40 and a fluency of 45. Subsequently in the distal anterior tibial artery above the ankle, the laser catheter could not be passed despite a fluency set at 50 and pulse rate set at 50. At this point the catheter was removed and a 2.0x220 cm Bard 0.018 wire balloon was taken over the PT2 moderate support wire w/o difficulty. Balloon angioplasty was performed from the ankle all the way up into the distal popliteal artery with 2 separate inflations at roughly 2 min. each at 12 atmospheres. The balloon expanded w/o waste.Follow-up angiogram showed uninterrupted in-line flow through the anterior tibial artery, however, there was still scattered areas of severe stenosis, which was then treated with a balloon angioplasty using a 3X300cm balloon for 2 min inflation at 12 atmospheres. Follow-up angiogram showed widely patent anterior tibial artery with scattered areas of moderate narrowing, but no high-grade stenosis. There was a brisk antegrade flow into the dorsalis pedis artery at the ankle and foot. There is no evidence of dissection. There was some residual minimal filling defect in the distal popliteal artery and extending into the peroneal artery, but brisk antegrade flow. The distal popliteal artery eccentric stenosis also appeared to be reduced to roughly 50%. At this point, the wire was removed. Attention was then turned to the left lower extremity. Limited angiogram was performed.

On the 75716. Angiography extremity, bilateral radiological supervision and INTERPRETATION. In order to bill for the bilateral leg shot we need the interpretation of both legs as the description says. These codes are not only coded for where the shot was done but also the interp. I see at the end of the report it says "limited angiogram was performed" Im thinking of the left extremity but I do not see the findings and if that is the case( I hope I didnt miss it, let me know if I did) . I would not use 75716. I would only use 75710,26,59. Let me know what you think!

 

[jdmjine]

On the 75716. Angiography extremity, bilateral radiological supervision and INTERPRETATION. In order to bill for the bilateral leg shot we need the interpretation of both legs as the description says. These codes are not only coded for where the shot was done but also the interp. I see at the end of the report it says "limited angiogram was performed" Im thinking of the left extremity but I do not see the findings and if that is the case( I hope I didnt miss it, let me know if I did) . I would not use 75716. I would only use 75710,26,59. Let me know what you think!

there was actually more, that wasn't the end of the report, here's the finding for the left extremity angio

" left superficial femoral artery is widely patent. the popliteal artery is widely patent , but below the knee, there is occlusion of the anterior tibial artery proximally with some scattered lumen in the mid vessel."

so is 37229 all I have besides the bilateral extremity angio?

 

[theresa.dix@tennova.com]

there was actually more, that wasn't the end of the report, here's the finding for the left extremity angio

" left superficial femoral artery is widely patent. the popliteal artery is widely patent , but below the knee, there is occlusion of the anterior tibial artery proximally with some scattered lumen in the mid vessel."

so is 37229 all I have besides the bilateral extremity angio?

Ok on the dictation for the legs and yes I would only report 37229 since it appears that the lesion extended across two territories and was treated with a single therapy. The rule is to only report one code. Even if two lesions were treated it is not dictated that way. Good deal

 

[Jim Pawloski]

there was actually more, that wasn't the end of the report, here's the finding for the left extremity angio

" left superficial femoral artery is widely patent. the popliteal artery is widely patent , but below the knee, there is occlusion of the anterior tibial artery proximally with some scattered lumen in the mid vessel."

so is 37229 all I have besides the bilateral extremity angio?

Of what I have read on this report, I only see an angioplasty and right lower extremity arteriogram. How can a left lower extremity angio be performed when an antegrade access was done in the right femoral artery. Is there more to this report that what was posted?

Jim Pawloski, CIRCC

 

[theresa.dix@tennova.com]

Of what I have read on this report, I only see an angioplasty and right lower extremity arteriogram. How can a left lower extremity angio be performed when an antegrade access was done in the right femoral artery. Is there more to this report that what was posted?

Jim Pawloski, CIRCC

Jim,
that was my question. See my answer and their response. Where it says " attention was then turned to the left lower extremity limited angiogram was performed. I questioned it and they said there was more to the report and told the findings on the left side. Left superficial femoral artery widely patent. ( see what they wrote under my answer). I am hoping that the report then said we moved contralateral to the left side and did a extremity shot. They have the results so they had to have done it. Only they can answer that.

 

[Jim Pawloski]

Jim,
that was my question. See my answer and their response. Where it says " attention was then turned to the left lower extremity limited angiogram was performed. I questioned it and they said there was more to the report and told the findings on the left side. Left superficial femoral artery widely patent. ( see what they wrote under my answer). I am hoping that the report then said we moved contralateral to the left side and did a extremity shot. They have the results so they had to have done it. Only they can answer that.

It would make sense if there was something in the order of "left femoral access performed, catheter placed in the abdominal aorta. Aortogram performed and catheter was brought down to the bifurcation and bilateral lower extremity arteriogram performed. Decision was made to access the right femoral using antegrade access...." But to do a antegrade access then spin the catheter around to go retrograde very difficult and somewhat dangerous in possibility tearing or have a dissection of the artery. The report needed to be re-done.

Thanks,
Jim