Wiki Please help - Celiac and Mesenteric Stents

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smiller

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Hello everyone - please help with coding - I don't have to code these very often, so I want to see if I'm on the right path for coding it. Any advice and/or help is appreciated. My codes are at the end of the report, so please check my coding - here it is:

1. Abdominal aortogram.
2. Selective injection of the renal arteries.
3. Selective injection of the vein graft to the left renal
artery.
4. Selective injection of the celiac artery.
5. Selective injection of the SMA.
6. PTA and stent implantation of the celiac.
7. PTA and stent implantation of the SMA.
8. Vascular closure of the right common femoral artery with a
MynxGrip device.
9. Conscious sedation.

INDICATIONS:
Intestinal angina.

PROCEDURE IN DETAIL:
Following arterial puncture of the right common femoral artery, I
placed a pigtail catheter in the super renal segment of the
abdominal aorta we performed abdominal aortography. We then
selected the renal arteries, the celiac access via SMA, and the
vein graft to the left renal artery. Arteriography demonstrated
a 95% celiac stenosis proximally. The SMA was functionally
occluded. The right renal artery was stented and contained a 25%
narrowing. The left renal artery was totally occluded. The vein
graft to the left renal artery was widely patent.

We then exchanged for a 7-French RDC I and stented the celiac
with a 6 x 19-mm length express SD stent to a normal appearance.
We moved on to the SMA and stented the functionally occluded SMA
with two overlapping 6 x 14-mm length express SD stents to a
normal appearance. We then closed the right femoral artery with
a MynxGrip device.






CONCLUSION
1. Normal appearance of the abdominal aorta.
2. Mild narrowing of the right renal artery.
3. Total occlusion of the left renal artery.
4. Widely patent saphenous vein graft to the left renal artery.
5. Significant narrowing of the celiac artery.
6. Functional occlusion of the SMA.
7. Successful PTA and stent implantation of the celiac access.
8. Successful PTA and stent implantation of the SMA.
9. Successful vascular closure of right common femoral artery
with a MynxGrip device.
10. Successful conscious sedation.

Here's my codes: 37205 - celiac
37206 - sma
36252 - selective bilateral renals
36245 x 2 - celiac and sma
75726-26-59 - celiac
75726-26-59 - sma
75774-26-59 - add'l inj to left renal artery vein graft
75960-26 - celiac
75960-26-59 - sma

Thank you in advance for any help.
 
smiller said:
Hello everyone - please help with coding - I don't have to code these very often, so I want to see if I'm on the right path for coding it. Any advice and/or help is appreciated. My codes are at the end of the report, so please check my coding - here it is:

1. Abdominal aortogram.
2. Selective injection of the renal arteries.
3. Selective injection of the vein graft to the left renal
artery.
4. Selective injection of the celiac artery.
5. Selective injection of the SMA.
6. PTA and stent implantation of the celiac.
7. PTA and stent implantation of the SMA.
8. Vascular closure of the right common femoral artery with a
MynxGrip device.
9. Conscious sedation.

INDICATIONS:
Intestinal angina.

PROCEDURE IN DETAIL:
Following arterial puncture of the right common femoral artery, I
placed a pigtail catheter in the super renal segment of the
abdominal aorta we performed abdominal aortography. We then
selected the renal arteries, the celiac access via SMA, and the
vein graft to the left renal artery. Arteriography demonstrated
a 95% celiac stenosis proximally. The SMA was functionally
occluded. The right renal artery was stented and contained a 25%
narrowing. The left renal artery was totally occluded. The vein
graft to the left renal artery was widely patent.

We then exchanged for a 7-French RDC I and stented the celiac
with a 6 x 19-mm length express SD stent to a normal appearance.
We moved on to the SMA and stented the functionally occluded SMA
with two overlapping 6 x 14-mm length express SD stents to a
normal appearance. We then closed the right femoral artery with
a MynxGrip device.






CONCLUSION
1. Normal appearance of the abdominal aorta.
2. Mild narrowing of the right renal artery.
3. Total occlusion of the left renal artery.
4. Widely patent saphenous vein graft to the left renal artery.
5. Significant narrowing of the celiac artery.
6. Functional occlusion of the SMA.
7. Successful PTA and stent implantation of the celiac access.
8. Successful PTA and stent implantation of the SMA.
9. Successful vascular closure of right common femoral artery
with a MynxGrip device.
10. Successful conscious sedation.

Here's my codes: 37205 - celiac
37206 - sma
36252 - selective bilateral renals
36245 x 2 - celiac and sma
75726-26-59 - celiac
75726-26-59 - sma
75774-26-59 - add'l inj to left renal artery vein graft
75960-26 - celiac
75960-26-59 - sma

Thank you in advance for any help.
Click to expand...

OK here goes...
37205/75960 for SMA stent
37206/75960 +36245-59 for celiac stent (and catheter placement for stent, not angio)
36247-59/75726 for sma angiography (and 3rd order selection of celiac axis through the sma.
75774 for addlt angio for celiac via sma injection.
36252 for renal angiographies (includes accessory arteries, so no add't for vein graft inj).

This is a complex case, and this is just my opinion.

HTH :)
 
smiller said:
Hello everyone - please help with coding - I don't have to code these very often, so I want to see if I'm on the right path for coding it. Any advice and/or help is appreciated. My codes are at the end of the report, so please check my coding - here it is:

1. Abdominal aortogram.
2. Selective injection of the renal arteries.
3. Selective injection of the vein graft to the left renal
artery.
4. Selective injection of the celiac artery.
5. Selective injection of the SMA.
6. PTA and stent implantation of the celiac.
7. PTA and stent implantation of the SMA.
8. Vascular closure of the right common femoral artery with a
MynxGrip device.
9. Conscious sedation.

INDICATIONS:
Intestinal angina.

PROCEDURE IN DETAIL:
Following arterial puncture of the right common femoral artery, I
placed a pigtail catheter in the super renal segment of the
abdominal aorta we performed abdominal aortography. We then
selected the renal arteries, the celiac access via SMA, and the
vein graft to the left renal artery. Arteriography demonstrated
a 95% celiac stenosis proximally. The SMA was functionally
occluded. The right renal artery was stented and contained a 25%
narrowing. The left renal artery was totally occluded. The vein
graft to the left renal artery was widely patent.

We then exchanged for a 7-French RDC I and stented the celiac
with a 6 x 19-mm length express SD stent to a normal appearance.
We moved on to the SMA and stented the functionally occluded SMA
with two overlapping 6 x 14-mm length express SD stents to a
normal appearance. We then closed the right femoral artery with
a MynxGrip device.






CONCLUSION
1. Normal appearance of the abdominal aorta.
2. Mild narrowing of the right renal artery.
3. Total occlusion of the left renal artery.
4. Widely patent saphenous vein graft to the left renal artery.
5. Significant narrowing of the celiac artery.
6. Functional occlusion of the SMA.
7. Successful PTA and stent implantation of the celiac access.
8. Successful PTA and stent implantation of the SMA.
9. Successful vascular closure of right common femoral artery
with a MynxGrip device.
10. Successful conscious sedation.

Here's my codes: 37205 - celiac
37206 - sma
36252 - selective bilateral renals
36245 x 2 - celiac and sma
75726-26-59 - celiac
75726-26-59 - sma
75774-26-59 - add'l inj to left renal artery vein graft
75960-26 - celiac
75960-26-59 - sma

Thank you in advance for any help.
Click to expand...

I would agree to all of you codes except for the renal vein graft. That would be bundled in 36252 (consider it a accessory renal artery).
HTH,
Jim Pawloski, CIRCC
 
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