carelitz
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I am questioning whether i can code the superior mesenteric artery with the bilateral renal angios. Thanks for any help!
The codes i possibly have are:
36252 (Bilateral renal artery angiogram)
37236 LT (Left inferior renal artery stent)
75726 59 (selective superior mesenteric artery angiogram)
36245 59 (first order cath placement)
99152
RENAL ANGIOGRAM/ INTERVENTION REPORT
Procedure performed:
SELECTIVE BILATERAL RENAL ARTERY ANGIOGRAM, INCLUDING SELECTIVE ANGIOGRAM OF RIGHT MAIN RENAL ARTERY, LEFT SUPERIOR RENAL ARTERY, AND SELECTIVE ANGIOGRAM OF LEFT INFERIOR RENAL ARTERY.
SELECTIVE SUPERIOR MESENTERIC ARTERY ANGIOGRAM.
LEFT INFERIOR RENAL ARTERY 5 X 19 MM STENT.
INDICATION FOR PROCEDURE:
This is a emale with history of type 2 diabetes, coronary artery disease, peripheral vascular disease, and difficult to control hypertension on 3 medications, who had more than 60% left renal artery stenosis on ultrasound, and atrophic right kidney.
Pros and cons of procedure were discussed, consent was obtained.
TECHNIQUE:
Vascular access obtained with micropuncture kit, and modified Seldinger technique to the right common femoral artery, and 5 French sheath introduced.
Five French IM catheter was used to selectively engage left superior renal artery, left inferior renal artery, superior mesenteric artery, and right main renal artery, angiograms were obtained in AP projection.
For angioplasty procedure sheath was exchanged to 6 French sheath, and 65 cm 6 French IM guiding catheter was used.
Perclose closure device successfully deployed to the right common femoral artery upon completion of the procedure.
Moderate sedation provided with IV Versed 2 mg, and fentanyl 50 mcg.
Local anesthesia to the right groin with 2% lidocaine -15 cc.
Blood loss was 5 cc.
Anticoagulation provided with IV heparin with ACT of 220, patient is on dual antiplatelet therapy with aspirin and Plavix.
There were no immediate complications.
RIGHT RENAL ANGIOGRAM:
Right renal artery is 100% chronically occluded proximally.
Left superior, and inferior renal branches had separate ostia from the left side of abdominal aorta.
LEFT SUPERIOR RENAL ANGIOGRAM:
Left superior renal artery is a large vessel with 50% proximal stenosis, and no evidence of poststenotic renal artery disease.
LEFT INFERIOR RENAL ANGIOGRAM:
Left inferior renal artery is a large vessel with 90% proximal stenosis, and no evidence of distal renal artery disease.
SUPERIOR MESENTERIC ARTERY ANGIOGRAM:
Superior mesenteric artery is a large vessel with mild luminal irregularities, but no evidence of obstructive disease.
LEFT INFERIOR RENAL ARTERY ANGIOPLASTY AND STENT:
Six French IM guiding catheter with no-touch technique was placed to the or still left inferior renal artery, and lesion crossed with 300 cm per core wire, which was navigated to the distal portion of the vessel. Then we advanced a 5 x 19 mm Express balloon expandable stent, and deployed it at nominal 11 atmospheres For 1 minutes, covering the ostium of the left inferior renal artery, the stent balloon was then partially pulled back, and again inflated, up to 14 atmospheres for another 30 seconds.
Final angiogram showed excellent procedural result, full stent expansion and apposition, no residual stenosis, no extravasation of dye or dissection, and excellent flow to the left inferior renal artery.
CONCLUSIONS:
The codes i possibly have are:
36252 (Bilateral renal artery angiogram)
37236 LT (Left inferior renal artery stent)
75726 59 (selective superior mesenteric artery angiogram)
36245 59 (first order cath placement)
99152
RENAL ANGIOGRAM/ INTERVENTION REPORT
Procedure performed:
SELECTIVE BILATERAL RENAL ARTERY ANGIOGRAM, INCLUDING SELECTIVE ANGIOGRAM OF RIGHT MAIN RENAL ARTERY, LEFT SUPERIOR RENAL ARTERY, AND SELECTIVE ANGIOGRAM OF LEFT INFERIOR RENAL ARTERY.
SELECTIVE SUPERIOR MESENTERIC ARTERY ANGIOGRAM.
LEFT INFERIOR RENAL ARTERY 5 X 19 MM STENT.
INDICATION FOR PROCEDURE:
This is a emale with history of type 2 diabetes, coronary artery disease, peripheral vascular disease, and difficult to control hypertension on 3 medications, who had more than 60% left renal artery stenosis on ultrasound, and atrophic right kidney.
Pros and cons of procedure were discussed, consent was obtained.
TECHNIQUE:
Vascular access obtained with micropuncture kit, and modified Seldinger technique to the right common femoral artery, and 5 French sheath introduced.
Five French IM catheter was used to selectively engage left superior renal artery, left inferior renal artery, superior mesenteric artery, and right main renal artery, angiograms were obtained in AP projection.
For angioplasty procedure sheath was exchanged to 6 French sheath, and 65 cm 6 French IM guiding catheter was used.
Perclose closure device successfully deployed to the right common femoral artery upon completion of the procedure.
Moderate sedation provided with IV Versed 2 mg, and fentanyl 50 mcg.
Local anesthesia to the right groin with 2% lidocaine -15 cc.
Blood loss was 5 cc.
Anticoagulation provided with IV heparin with ACT of 220, patient is on dual antiplatelet therapy with aspirin and Plavix.
There were no immediate complications.
RIGHT RENAL ANGIOGRAM:
Right renal artery is 100% chronically occluded proximally.
Left superior, and inferior renal branches had separate ostia from the left side of abdominal aorta.
LEFT SUPERIOR RENAL ANGIOGRAM:
Left superior renal artery is a large vessel with 50% proximal stenosis, and no evidence of poststenotic renal artery disease.
LEFT INFERIOR RENAL ANGIOGRAM:
Left inferior renal artery is a large vessel with 90% proximal stenosis, and no evidence of distal renal artery disease.
SUPERIOR MESENTERIC ARTERY ANGIOGRAM:
Superior mesenteric artery is a large vessel with mild luminal irregularities, but no evidence of obstructive disease.
LEFT INFERIOR RENAL ARTERY ANGIOPLASTY AND STENT:
Six French IM guiding catheter with no-touch technique was placed to the or still left inferior renal artery, and lesion crossed with 300 cm per core wire, which was navigated to the distal portion of the vessel. Then we advanced a 5 x 19 mm Express balloon expandable stent, and deployed it at nominal 11 atmospheres For 1 minutes, covering the ostium of the left inferior renal artery, the stent balloon was then partially pulled back, and again inflated, up to 14 atmospheres for another 30 seconds.
Final angiogram showed excellent procedural result, full stent expansion and apposition, no residual stenosis, no extravasation of dye or dissection, and excellent flow to the left inferior renal artery.
CONCLUSIONS:
- SYMPTOMATIC RENAL ARTERY STENOSIS, 100% OCCLUDED RIGHT RENAL ARTERY WITH HYPERTROPHIC KIDNEY, 50% PROXIMAL STENOSIS OF THE LEFT SUPERIOR RENAL ARTERY, 90% PROXIMAL STENOSIS OF THE LEFT INFERIOR RENAL ARTERY.
- SUCCESSFUL ANGIOPLASTY AND 5 X 19 MM EXPRESS STENT TO THE LEFT INFERIOR RENAL ARTERY.
- MEDICAL THERAPY FOR THE INTERMEDIATE STENOSIS OF THE LEFT SUPERIOR RENAL ARTERY.
- PATIENT TO CONTINUE DUAL ANTIPLATELET THERAPY WITH ASPIRIN AND PLAVIX, AND RECOMMEND NONINVASIVE EVALUATION OF PERIPHERAL VASCULAR DISEASE, AS THERE WAS EVIDENCE OF SIGNIFICANT RIGHT SFA STENOSIS BY FEMORAL ANGIOGRAM.
This was the first time i saw this specific angiogram.