PLEASE HELP brand new to IR codeing

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Please I really need some help - I am trying to code this out but I am at a lost and I am sure this codes are not correct

37225
36246/36245?
75726
75774 x 2?

did he do a graph 35666?

Please help



PROCEDURE: BALLOON ANGIOPLASTY OF ANASTOMOSIS OF ARTERIAL JUMP
GRAFT WITH AORTOGRAPHY AND ANGIOGRAPHY OF THE LOWER EXTREMITIES.

INDICATIONS: SEVERE PERIPHERAL ARTERIAL DISEASE WITH PRIOR
ABOVE-THE-KNEE AMPUTATION ON THE LEFT AND PREVIOUS JUMP GRAFT FROM THE
PROFUNDA ON THE RIGHT KIDNEY POSTERIOR TIBIAL WITH PRIOR HISTORY OF
DISTAL POSTERIOR TIBIAL OCCLUSION. INTERVAL ULTRASOUND SHOWS STENOSIS
AT THE ORIGIN OF THE VENOUS JUMP GRAFT. THE SUPERFICIAL FEMORAL
ARTERY IS OCCLUDED. DR. MITCHELL WAS INVOLVED IN AN EMERGENCY CASE
AND REQUESTED THAT I PERFORMED THE PROCEDURE THAT WAS SCHEDULED FOR
HER. AFTER DISCUSSING WITH THE PATIENT, HE WAS AMENABLE TO PROCEEDING
WITH ME AS THE PRIMARY OPERATOR.

CONSENT: THE RISKS BENEFITS AND ALTERNATIVES OF THE PROCEDURE WERE
DISCUSSED IN DETAIL WITH THE PATIENT. THE PATIENT WAS GIVEN AMPLE
TIME TO ASK QUESTIONS AND WHEN SATISFIED A WRITTEN INFORMED CONSENT
FORM WAS SUBMITTED. THE RISKS INCLUDE BUT ARE NOT LIMITED TO PAIN,
INFECTION, BLEEDING, PNEUMOTHORAX, DAMAGE TO ADJACENT TISSUES, NEED
FOR FUTURE PROCEDURES, AND DEATH.

OPERATIONS:
1. ULTRASOUND-GUIDED ACCESS TO THE LEFT COMMON FEMORAL ARTERY,
IMAGES WERE SAVED FOR THE MEDICAL RECORD.
2. NONSELECTIVE CATHETER PLACEMENT THE DISTAL AORTA.
3. PELVIC ANGIOGRAPHY FROM THE DISTAL AORTA AT THE LEVEL OF THE
ILIAC BIFURCATION IN TWO OBLIQUITIES.
4. RUNOFF ANGIOGRAPHY OF THE RIGHT LOWER EXTREMITY THROUGH THE
JUMP GRAFT TO THE LEVEL OF THE CALF.
5. BALLOON ANGIOPLASTY TO 6 MM AT THE PROXIMAL ANASTOMOSIS OF THE
BYPASS GRAFT EXTENDING FROM THE PROFUNDA ARTERY TO THE POSTERIOR
TIBIAL ARTERY.
6. COMPLETION ANGIOGRAM OF THE RIGHT COMMON FEMORAL ARTERY THROUGH
THE PROXIMAL GRAFT.

TECHNIQUE:
PATIENT WAS BROUGHT TO THE ANGIOGRAPHY SUITE AND LAID SUPINE. THE
LEFT GROIN WAS PREPPED AND DRAPED IN STANDARD STERILE FASHION.
ULTRASOUND WAS USED FOR NEEDLE ACCESS INTO THE LEFT COMMON FEMORAL
ARTERY AND AN IMAGE WAS SAVED FOR THE MEDICAL RECORD. THERE WAS GREAT
DIFFICULTY PASSING A SHEATH INTO THE SCARRED LEFT GROIN, BUT
EVENTUALLY A 6-FRENCH DESTINATION SHEATH WAS ABLE TO PASS AND ADVANCED
INTO THE LEFT EXTERNAL ILIAC ARTERY. DIAGNOSTIC CATHETER WAS ADVANCED
TO THE DISTAL AORTA. THIS CATHETER WAS PULLED OVER THE BIFURCATION
AND DISTAL AORTOGRAPHY AT THE LEVEL OF THE ILIAC BIFURCATION WAS
PERFORMED OF THE PELVIC VESSELS IN 2 OBLIQUITIES. THE TABLE WAS MOVED
AND RUNOFF ANGIOGRAPHY WAS PERFORMED THROUGH THE RIGHT LOWER EXTREMITY
THROUGH THE JUNK GRAFT TO THE LEVEL OF THE CALF. 5000 UNITS OF
HEPARIN WERE MINISTER INTRAVENOUSLY. USING THESE PLANNING ANGIOGRAMS,
DIAGNOSTIC CATHETER WAS PASSED THROUGH THE ANASTOMOSIS INTO THE VENOUS
JUMP GRAFT. A WIRE WAS ADVANCED DISTALLY. THE CATHETER WAS REMOVED
AND EXCHANGED FOR A 5 MM X 20 MM BALLOON WHICH WAS ADVANCED TO THE
LEVEL OF AN APPARENT STENOSIS AT THE ORIGIN OF THE PROFUNDA TO
POSTERIOR TIBIAL VENOUS GRAFT. AFTER BALLOON ANGIOPLASTY, FOLLOW-UP
ANGIOGRAM WAS PERFORMED AND SHOWED SOME RESIDUAL STENOSIS. A 6 MM X
20 MM BALLOON WAS ADVANCED TO THE SAME LEVEL AND INFLATED TO BURST
PRESSURE. FOLLOW-UP ANGIOGRAM SHOWS RAPID FLOW THROUGH THE ORIGIN OF
THE ANASTOMOSIS AND GOOD OPACIFICATION OF THE ENTIRETY OF THE PROXIMAL
END OF THE VENOUS STENT. THE DIAGNOSTIC CATHETER AND SHEATH WERE
REMOVED AND EXCHANGED FOR A 6-FRENCH SHORT SHEATH. AN OBTURATOR WAS
PLACED WITHIN THE SHEATH AND THE PATIENT SENT TO THE RECOVERY AREA FOR
REMOVAL OF THE CATHETER WHEN THE ACT IS APPROPRIATE. DR. MITCHELL WAS
PRESENT FOR THE TERMINATION OF THE PROCEDURE AND MANAGED THE ORDERS
FOR DISCHARGE.

FINDINGS:
1. ULTRASOUND SHOWS ECHOGENIC PLAQUE AT THE SITE OF THE COMMON
FEMORAL ARTERY. THE ARTERY IS LARGE ENOUGH FOR PASSAGE OF THE SHEATH.
2. INTRAPROCEDURAL IMAGES SHOW THE DIAGNOSTIC CATHETER AT THE
DISTAL AORTA ABOVE THE BIFURCATION.
3. PELVIC ANGIOGRAPHY IN 2 OBLIQUITIES SHOWS NO HIGH-GRADE FOCAL
STENOSIS WITHIN THE FIELD-OF-VIEW IN THE LEFT EXTERNAL ILIAC ARTERY.
THE LEFT INTERNAL ILIAC ARTERY IS NOT OPACIFIED. THE LEFT PROFUNDA
ARTERY REMAINS IN THE LEFT SUPERFICIAL FEMORAL ARTERY IS OCCLUDED.
THE RIGHT INTERNAL ILIAC ARTERY IS PATENT AT ITS ORIGIN. THERE IS NO
HIGH-GRADE STENOSIS ALONG THE COURSE OF THE EXTERNAL ILIAC ARTERY OR
WITHIN THE PROXIMAL PORTION OF THE COMMON FEMORAL ARTERY. THERE ARE
SEVERAL OCCLUDED ATTEMPTS AT PRIOR GRAFTS IN THE COMMON FEMORAL
ARTERY. THERE IS APPARENT STENOSIS OF THE ORIGIN OF THE JUMP GRAFT
BUT FLOW REMAINS THROUGH THE GRAFT PROXIMALLY AT THE RIGHT PROFUNDA
FEMORIS ARTERY. THE PATIENT IS STATUS POST LEFT ABOVE-THE-KNEE
AMPUTATION. THERE ARE BILATERAL HIP ARTHROPLASTIES.
4. RUNOFF ANGIOGRAPHY DEMONSTRATES THE GRAFT TO BE PATENT THROUGH
ITS COURSE TO THE CALF WHERE IT JOINS THE POSTERIOR TIBIAL ARTERY WITH
BACKFLOW INTO THE PERONEAL ARTERY AND ANTERIOR TIBIAL ARTERIES WITH
FLOW DISTALLY VIA COLLATERALS. THE PROFUNDA FEMORIS ARTERY IS WIDELY
PATENT ON THE RIGHT.
5. INTRAPROCEDURAL IMAGES DEMONSTRATE BALLOON ANGIOPLASTY AT THE
ORIGIN OF THE JUMP GRAFT EXTENDING FROM THE RIGHT PROFUNDA FEMORIS TO
THE RIGHT POSTERIOR TIBIAL ARTERY.
6. COMPLETION ANGIOGRAM SHOWS IMPROVED FLOW THROUGH THE PROXIMAL
END OF THE JUMP GRAFT WITH RELIEF OF 2 TANDEM STENOSES WHICH ARE VERY
CLOSE TO EACH OTHER AT THE ORIGIN OF THE GRAFT.

MODERATE SEDATION TIME: TOTAL OF 75 MINUTES OF MODERATE SEDATION WAS
PERFORMED WITH DEDICATED NURSE MONITORING UNDER MY DIRECT SUPERVISION
PER HOSPITAL PROTOCOL.

MEDICATION: PLEASE SEE MAR FOR SEDATION DOSES. 5000 UNITS HEPARIN IV.
LIDOCAINE FOR LOCAL ANESTHESIA.

RADIATION: CUMULATIVE DAP (FLUOROSCOPY): 32,982 MGYCM2 CODE: G9500-0

CONTRAST: 130 ML ISOVUE-370

COMPLICATIONS: NONE IMMEDIATE

STANDARDIZED STERILE TECHNIQUE WAS USED, INCLUDING: MAXIMAL STERILE
BARRIER TECHNIQUE, HAND HYGIENE, SKIN PREPARATION, AND STERILE
ULTRASOUND TECHNIQUE. CODE 6030F AH0C

PLEASE NOTE THAT IMAGES ARE AVAILABLE IN DICOM FORMAT TO
NON-AFFILIATED EXTERNAL HEALTHCARE FACILITIES WITH PATIENT CONSENT.
CODE G9340.

CASE DISCUSSED WITH DR. MITCHELL IN PERSON AT AT THE TERMINATION OF
THE PROCEDURE. SHE WILL MANAGE THE ORDERS FOR DISCHARGE AND CLINICAL
FOLLOW-UP OF THE PATIENT.

IMPRESSION:

1. TECHNICALLY SUCCESSFUL BALLOON ANGIOPLASTY AT THE ORIGIN OF A
VENOUS JUMP GRAFT EXTENDING FROM THE RIGHT PROFUNDA ARTERY TO THE
RIGHT POSTERIOR TIBIAL ARTERY WITH IMPROVED FLOW THROUGH THE GRAFT AND
RELIEF OF 2 TANDEM STENOSES VERY NEAR THE ORIGIN
 

Jim Pawloski

True Blue
Messages
1,247
Location
Ann Arbor
Best answers
0
Please I really need some help - I am trying to code this out but I am at a lost and I am sure this codes are not correct

37225
36246/36245?
75726
75774 x 2?

did he do a graph 35666?

Please help



PROCEDURE: BALLOON ANGIOPLASTY OF ANASTOMOSIS OF ARTERIAL JUMP
GRAFT WITH AORTOGRAPHY AND ANGIOGRAPHY OF THE LOWER EXTREMITIES.

INDICATIONS: SEVERE PERIPHERAL ARTERIAL DISEASE WITH PRIOR
ABOVE-THE-KNEE AMPUTATION ON THE LEFT AND PREVIOUS JUMP GRAFT FROM THE
PROFUNDA ON THE RIGHT KIDNEY POSTERIOR TIBIAL WITH PRIOR HISTORY OF
DISTAL POSTERIOR TIBIAL OCCLUSION. INTERVAL ULTRASOUND SHOWS STENOSIS
AT THE ORIGIN OF THE VENOUS JUMP GRAFT. THE SUPERFICIAL FEMORAL
ARTERY IS OCCLUDED. DR. MITCHELL WAS INVOLVED IN AN EMERGENCY CASE
AND REQUESTED THAT I PERFORMED THE PROCEDURE THAT WAS SCHEDULED FOR
HER. AFTER DISCUSSING WITH THE PATIENT, HE WAS AMENABLE TO PROCEEDING
WITH ME AS THE PRIMARY OPERATOR.

CONSENT: THE RISKS BENEFITS AND ALTERNATIVES OF THE PROCEDURE WERE
DISCUSSED IN DETAIL WITH THE PATIENT. THE PATIENT WAS GIVEN AMPLE
TIME TO ASK QUESTIONS AND WHEN SATISFIED A WRITTEN INFORMED CONSENT
FORM WAS SUBMITTED. THE RISKS INCLUDE BUT ARE NOT LIMITED TO PAIN,
INFECTION, BLEEDING, PNEUMOTHORAX, DAMAGE TO ADJACENT TISSUES, NEED
FOR FUTURE PROCEDURES, AND DEATH.

OPERATIONS:
1. ULTRASOUND-GUIDED ACCESS TO THE LEFT COMMON FEMORAL ARTERY,
IMAGES WERE SAVED FOR THE MEDICAL RECORD.
2. NONSELECTIVE CATHETER PLACEMENT THE DISTAL AORTA.
3. PELVIC ANGIOGRAPHY FROM THE DISTAL AORTA AT THE LEVEL OF THE
ILIAC BIFURCATION IN TWO OBLIQUITIES.
4. RUNOFF ANGIOGRAPHY OF THE RIGHT LOWER EXTREMITY THROUGH THE
JUMP GRAFT TO THE LEVEL OF THE CALF.
5. BALLOON ANGIOPLASTY TO 6 MM AT THE PROXIMAL ANASTOMOSIS OF THE
BYPASS GRAFT EXTENDING FROM THE PROFUNDA ARTERY TO THE POSTERIOR
TIBIAL ARTERY.
6. COMPLETION ANGIOGRAM OF THE RIGHT COMMON FEMORAL ARTERY THROUGH
THE PROXIMAL GRAFT.

TECHNIQUE:
PATIENT WAS BROUGHT TO THE ANGIOGRAPHY SUITE AND LAID SUPINE. THE
LEFT GROIN WAS PREPPED AND DRAPED IN STANDARD STERILE FASHION.
ULTRASOUND WAS USED FOR NEEDLE ACCESS INTO THE LEFT COMMON FEMORAL
ARTERY AND AN IMAGE WAS SAVED FOR THE MEDICAL RECORD. THERE WAS GREAT
DIFFICULTY PASSING A SHEATH INTO THE SCARRED LEFT GROIN, BUT
EVENTUALLY A 6-FRENCH DESTINATION SHEATH WAS ABLE TO PASS AND ADVANCED
INTO THE LEFT EXTERNAL ILIAC ARTERY. DIAGNOSTIC CATHETER WAS ADVANCED
TO THE DISTAL AORTA. THIS CATHETER WAS PULLED OVER THE BIFURCATION
AND DISTAL AORTOGRAPHY AT THE LEVEL OF THE ILIAC BIFURCATION WAS
PERFORMED OF THE PELVIC VESSELS IN 2 OBLIQUITIES. THE TABLE WAS MOVED
AND RUNOFF ANGIOGRAPHY WAS PERFORMED THROUGH THE RIGHT LOWER EXTREMITY
THROUGH THE JUNK GRAFT TO THE LEVEL OF THE CALF. 5000 UNITS OF
HEPARIN WERE MINISTER INTRAVENOUSLY. USING THESE PLANNING ANGIOGRAMS,
DIAGNOSTIC CATHETER WAS PASSED THROUGH THE ANASTOMOSIS INTO THE VENOUS
JUMP GRAFT. A WIRE WAS ADVANCED DISTALLY. THE CATHETER WAS REMOVED
AND EXCHANGED FOR A 5 MM X 20 MM BALLOON WHICH WAS ADVANCED TO THE
LEVEL OF AN APPARENT STENOSIS AT THE ORIGIN OF THE PROFUNDA TO
POSTERIOR TIBIAL VENOUS GRAFT. AFTER BALLOON ANGIOPLASTY, FOLLOW-UP
ANGIOGRAM WAS PERFORMED AND SHOWED SOME RESIDUAL STENOSIS. A 6 MM X
20 MM BALLOON WAS ADVANCED TO THE SAME LEVEL AND INFLATED TO BURST
PRESSURE. FOLLOW-UP ANGIOGRAM SHOWS RAPID FLOW THROUGH THE ORIGIN OF
THE ANASTOMOSIS AND GOOD OPACIFICATION OF THE ENTIRETY OF THE PROXIMAL
END OF THE VENOUS STENT. THE DIAGNOSTIC CATHETER AND SHEATH WERE
REMOVED AND EXCHANGED FOR A 6-FRENCH SHORT SHEATH. AN OBTURATOR WAS
PLACED WITHIN THE SHEATH AND THE PATIENT SENT TO THE RECOVERY AREA FOR
REMOVAL OF THE CATHETER WHEN THE ACT IS APPROPRIATE. DR. MITCHELL WAS
PRESENT FOR THE TERMINATION OF THE PROCEDURE AND MANAGED THE ORDERS
FOR DISCHARGE.

FINDINGS:
1. ULTRASOUND SHOWS ECHOGENIC PLAQUE AT THE SITE OF THE COMMON
FEMORAL ARTERY. THE ARTERY IS LARGE ENOUGH FOR PASSAGE OF THE SHEATH.
2. INTRAPROCEDURAL IMAGES SHOW THE DIAGNOSTIC CATHETER AT THE
DISTAL AORTA ABOVE THE BIFURCATION.
3. PELVIC ANGIOGRAPHY IN 2 OBLIQUITIES SHOWS NO HIGH-GRADE FOCAL
STENOSIS WITHIN THE FIELD-OF-VIEW IN THE LEFT EXTERNAL ILIAC ARTERY.
THE LEFT INTERNAL ILIAC ARTERY IS NOT OPACIFIED. THE LEFT PROFUNDA
ARTERY REMAINS IN THE LEFT SUPERFICIAL FEMORAL ARTERY IS OCCLUDED.
THE RIGHT INTERNAL ILIAC ARTERY IS PATENT AT ITS ORIGIN. THERE IS NO
HIGH-GRADE STENOSIS ALONG THE COURSE OF THE EXTERNAL ILIAC ARTERY OR
WITHIN THE PROXIMAL PORTION OF THE COMMON FEMORAL ARTERY. THERE ARE
SEVERAL OCCLUDED ATTEMPTS AT PRIOR GRAFTS IN THE COMMON FEMORAL
ARTERY. THERE IS APPARENT STENOSIS OF THE ORIGIN OF THE JUMP GRAFT
BUT FLOW REMAINS THROUGH THE GRAFT PROXIMALLY AT THE RIGHT PROFUNDA
FEMORIS ARTERY. THE PATIENT IS STATUS POST LEFT ABOVE-THE-KNEE
AMPUTATION. THERE ARE BILATERAL HIP ARTHROPLASTIES.
4. RUNOFF ANGIOGRAPHY DEMONSTRATES THE GRAFT TO BE PATENT THROUGH
ITS COURSE TO THE CALF WHERE IT JOINS THE POSTERIOR TIBIAL ARTERY WITH
BACKFLOW INTO THE PERONEAL ARTERY AND ANTERIOR TIBIAL ARTERIES WITH
FLOW DISTALLY VIA COLLATERALS. THE PROFUNDA FEMORIS ARTERY IS WIDELY
PATENT ON THE RIGHT.
5. INTRAPROCEDURAL IMAGES DEMONSTRATE BALLOON ANGIOPLASTY AT THE
ORIGIN OF THE JUMP GRAFT EXTENDING FROM THE RIGHT PROFUNDA FEMORIS TO
THE RIGHT POSTERIOR TIBIAL ARTERY.
6. COMPLETION ANGIOGRAM SHOWS IMPROVED FLOW THROUGH THE PROXIMAL
END OF THE JUMP GRAFT WITH RELIEF OF 2 TANDEM STENOSES WHICH ARE VERY
CLOSE TO EACH OTHER AT THE ORIGIN OF THE GRAFT.

MODERATE SEDATION TIME: TOTAL OF 75 MINUTES OF MODERATE SEDATION WAS
PERFORMED WITH DEDICATED NURSE MONITORING UNDER MY DIRECT SUPERVISION
PER HOSPITAL PROTOCOL.

MEDICATION: PLEASE SEE MAR FOR SEDATION DOSES. 5000 UNITS HEPARIN IV.
LIDOCAINE FOR LOCAL ANESTHESIA.

RADIATION: CUMULATIVE DAP (FLUOROSCOPY): 32,982 MGYCM2 CODE: G9500-0

CONTRAST: 130 ML ISOVUE-370

COMPLICATIONS: NONE IMMEDIATE

STANDARDIZED STERILE TECHNIQUE WAS USED, INCLUDING: MAXIMAL STERILE
BARRIER TECHNIQUE, HAND HYGIENE, SKIN PREPARATION, AND STERILE
ULTRASOUND TECHNIQUE. CODE 6030F AH0C

PLEASE NOTE THAT IMAGES ARE AVAILABLE IN DICOM FORMAT TO
NON-AFFILIATED EXTERNAL HEALTHCARE FACILITIES WITH PATIENT CONSENT.
CODE G9340.

CASE DISCUSSED WITH DR. MITCHELL IN PERSON AT AT THE TERMINATION OF
THE PROCEDURE. SHE WILL MANAGE THE ORDERS FOR DISCHARGE AND CLINICAL
FOLLOW-UP OF THE PATIENT.

IMPRESSION:

1. TECHNICALLY SUCCESSFUL BALLOON ANGIOPLASTY AT THE ORIGIN OF A
VENOUS JUMP GRAFT EXTENDING FROM THE RIGHT PROFUNDA ARTERY TO THE
RIGHT POSTERIOR TIBIAL ARTERY WITH IMPROVED FLOW THROUGH THE GRAFT AND
RELIEF OF 2 TANDEM STENOSES VERY NEAR THE ORIGIN
Thanks for the interesting case. First since an intervention was performed in the lower extremity, catheter placement is bundled in the intervention. Since angioplasty was performed in the fem-pop region, code 37224. for imaging, the catheter was placed just above the aortic bifurcation, I would not code that. But the right lower extremity was imaged, so you code 75710-rt for that. 75726 is for imaging of either the celiac, SMA, ima or bronchial arteries, which was not performed so delete 75726. Any imaging after intervention is bundled in the intervention or as a "roadmap", so do not bill 75774. So what you should have is 37224-RT, 75710-RT,59. The graft replaced the native artery, so consider it as the native artery.
HTH,
Jim Pawloski, CIRCC
 
Messages
13
Best answers
0
Thank you so much - I really appreciate your help - hopefully I can ask you for help in the future - I am trying to get my certification with IR - I have my CPC but now I want to focus on IR. Do you have any pointers or help with that process? What worked for you online classes, study guide, sample questions? How much time did you give for studying for the test?
 

SENTHIL05

Contributor
Messages
13
Best answers
0
If the Graft not extend from Profunda femoral you have also to code for Posterior Tibial angioplasty 37228.
 
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