Wiki Renal Cath

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PROCEDURE: Renal angiogram and angioplasty.
INDICATIONS: Secondary hypertension, renal vascular procedure, access from the right common femoral artery, second order catheter placement with bilateral selective renal angiography and unilateral right renal artery stent.
HISTORY OF PRESENT ILLNESS: The patient is a 72-year-old with history of coronary artery disease, peripheral artery disease, previous stroke, previous CA, known right renal artery disease who presents with resistant hypertension. She has had ongoing challenges with medication intolerance and blood pressure control. She has been maximized on optimal medical therapy. Followup renal Doppler sonography demonstrated greater than 60% right renal artery stenosis. In the context of optimal medical therapy, however, persistent resistant secondary hypertension. She is referred for renal angiography.
PROCEDURE DESCRIPTION: Informed consent was obtained. The patient understood the risks, benefits and alternatives of the procedure and agreed to proceed with the procedure. The right groin was prepped in the usual sterile fashion and 2% lidocaine infused subcutaneously until adequate anesthesia was obtained. Right common femoral artery was accessed using modified Seldinger technique. A 6-French, 11-cm sheath was placed without complication. Diagnostic 5-French IMA as well as a JR4 were used for selective bilateral renal angiography and placement in the second order vessel. At the conclusion of the procedure, an Angio-Seal device was used for arterial hemostasis.
FINDINGS: Selective catheter placement in the left renal artery demonstrated patent vessel with only mild disease and good filling of all arcades with normal size of the kidney. Selective catheter placement and injection of the right renal artery demonstrated critical 99% ostial stenosis and tortuosity at the ostium with extensive calcification. There was hypoperfusion to the kidney; however, size appeared normal..
Based on the patient's clinical presentation and angiographic findings, it was elected then to proceed with this new information with balloon angioplasty and stenting as indicated to the right renal artery.
INTERVENTION: Angiomax was used for effective anticoagulation, and multiple guides were attempted including a JR4 hockey stick, and eventually an AR1 guide was used for selective injection and placement into the right renal artery. A Runthrough wire was placed to a superior renal artery. 2.0 and then 3.0 balloons were used for predilatation, and a 6.0 x 15 Herculink bare metal stent was then deployed and flared at 14 atmospheres with an excellent angiographic result, TIMI 3 flow and 0% residual stenosis.
SUMMARY: Successful percutaneous renal stenting of the right renal artery with placement of a Herculink bare-metal stent.
Not sure if code for Renal cath is 36254? Thanks Nancy
Renal cath


The report is conflicting and may require clarification and/or an amendment on the physicians part. They documented under the procedure technique selective bilateral placement in a second order vessel, but failed to document which vessel(s). Since the findings document renal artery I would suggest using the first order code 36252 since renal artery is typically interpreted as the main renal artery unless otherwise specified. Only the following arteries are considered second order and above: capsular and perirenal branches, anterior superior segmental artery, superior segmental artery, anterior inferior segmental artery, and/or interlobar arteries.