Wiki Renal stent coding, help.

[aunderhill]

Hello, can you please help with this renal stent claim. 4 IVUS guided stents in the main renals and accessory renals. I am just not sure if you break it out by lateral sides or group them.

37236, RT - 37236, LT -37237, RT - 37237, LT, 37252, RT - 37253, RT - 37252, LT - 37253, LT
or
37236,50 - 37237,50 - 37252,50 - 37253,50
or
37236, 37237 x3 - 37252, 37253 x3

How would you code this claim?
Thank you so much in advance!

PROCEDURES PERFORMED:

1. Ultrasound-guided access to the right common femoral artery

2. Selective left main renal artery angiography

3. Intravascular ultrasound of the left main renal artery

4. Stenting of the left main renal artery

5. Selective angiography of the accessory left renal artery

6. Intravascular ultrasound of the accessory left renal artery

7. Stenting of the accessory left renal artery

8. Selective right main renal artery angiography

9. Intravascular ultrasound of the right main renal artery

10. Stenting of the right main renal artery

11. Selective angiography of the accessory right renal artery

12. Intravascular ultrasound of the accessory right renal artery

13. Stenting of the accessory right renal artery

14. Right common femoral artery angiography

15. Deployment of a 6 French Perclose hemostatic closure device to the right common femoral artery.

SEDATION: Conscious sedation was provided by a trained nurse with intravenous boluses of fentanyl and Versed for a total of 90 minutes.

COMPLICATIONS: None.

ESTIMATED BLOOD LOSS: 10 mL.

INTERVENTIONAL TECHNIQUE: After explaining the risks and benefits of the procedure, informed consent was obtained, the patient was brought to the cardiac catheterization laboratory, prepared and draped in the usual sterile fashion. A 1% lidocaine solution was used to anesthetize the right groin area. Access to the right common femoral artery was obtained by using ultrasound and fluoroscopic guidance with a micropuncture set, then a 6 French 10 cm sheath was advanced over 0.035 wire. She was anticoagulated with intravenous heparin to achieve an ACT of greater than 250 seconds, and received clopidogrel 600 mg oral bolus, and a total of 325 mg of aspirin.

Intravascular ultrasound (IVUS) guided stenting of the inferior left main renal artery: The left main renal artery was selectively engage using a none-touch technique with a 0.018 steel core wire in the aorta and a 0.014 wire Scion who was used to cross the lesion in the mid left main renal artery. Angiography demonstrated a 60 to 70% stenosis in the mid left main renal artery. Intravascular ultrasound showed a reference luminal diameter of 5.0 mm, severe calcification, and greater than 60% stenosis. We then proceeded to perform balloon angioplasty using a 4.0 x 20 mm balloon inflated at 16 atm. And then stented the mid left main renal artery with a 5.0 x 19 mm express SD balloon expandable stent deployed at 16 atm. The final angiographic result was excellent with TIMI-3 flow, no evidence of dissection and no residual stenosis.

Intravascular ultrasound (IVUS) guided stenting of the accessory superior left renal artery: The accessory left renal artery electively engage using a none-touch technique with a 0.018 steel core wire in the aorta and a 0.014 wire Scion who was used to cross the lesion in the ostium of the accessory left renal artery. Angiography demonstrated a 60 to 70% stenosis in the ostium of the left main renal artery. Intravascular ultrasound showed a reference luminal diameter of 4 .0 mm, mild calcification, and greater than 60% stenosis. We then proceeded to perform balloon angioplasty using a 3.0 x 12 mm balloon inflated at 16 atm. And then stented the ostium of the accessory left renal artery with a 4.0 x 19 mm express SD balloon expandable stent deployed at 16 atm. The final angiographic result was excellent with TIMI-3 flow, no evidence of dissection and no residual stenosis.

Intravascular ultrasound (IVUS) guided stenting of the superior accessory right renal artery: The accessory right renal artery electively engage using a none-touch technique with a 0.018 steel core wire in the aorta and a 0.014 wire Scion who was used to cross the lesion in the ostium of the accessory right renal artery. Angiography demonstrated a 60 to 70% stenosis in the ostium of the right main renal artery. Intravascular ultrasound showed a reference luminal diameter of 4 .0 mm, mild calcification, and greater than 60% stenosis. We then proceeded to perform balloon angioplasty using a 3.0 x 12 mm balloon inflated at 16 atm. And then stented the ostium of the accessory left renal artery with a Synergy XD Megatron 4.0 x 16 mm balloon expandable stent deployed at 16 atm. The final angiographic result was excellent with TIMI-3 flow, no evidence of dissection and no residual stenosis.

Intravascular ultrasound (IVUS) guided stenting of the inferior right main renal artery: The right main renal artery was selectively engage using a none-touch technique with a 0.018 steel core wire in the aorta and a 0.014 wire Scion who was used to cross the lesion in the mid left main renal artery. Angiography demonstrated a 60 to 70% stenosis in the mid left main renal artery. Intravascular ultrasound showed a reference luminal diameter of 5.0 mm, moderate calcification, and greater than 60% stenosis. We then proceeded to perform balloon angioplasty using a 4.0 x 12 mm balloon inflated at 16 atm. And then stented the mid left main renal artery with a 5.0 x 15 mm express SD balloon expandable stent deployed at 16 atm. The final angiographic result was excellent with TIMI-3 flow, no evidence of dissection and no residual stenosis.

Then the guiding catheter was removed over a 0.035 wire. Then right common femoral artery hemostasis was achieved by successfully deploying a 6 French Perclose hemostatic closure device. The groin was dressed in the usual sterile fashion a FemoStop was placed at 30 mmHg and the patient was transferred to the recovery area in stable condition.

CONCLUSIONS:

1. Status post successful intravascular ultrasound-guided stenting of bilateral main and accessory renal arteries ( 4 renal arteries stented).

 

[Jim Pawloski]

I like your option # 3. 37252 can only be used once along with 36236, as in one vessel. So the other vessels are covered with 37253 and 36237.
HTH,
Jim