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Shirleybala

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Hello:

How many stents I have to code for the below report,confusing please help.

Aortogram, left lower extremity angiogram, iliac stenting and aortic
stenting.
After obtaining informed consent, the patient was placed on the x-ray
table. Using ultrasound guidance, the left common femoral artery was
punctured and a 6 Fr. sheath was placed through a wire into the common
femoral artery. Angiogram revealed occlusion of the left common iliac
artery.
A wire was placed into the iliac artery but this appeared to be in a
false lumen.
The patient's right groin was prepped and draped in sterile fashion.
Using ultrasound guidance, the right common femoral artery was punctured
and a 6 Fr. sheath was placed into the common femoral artery. Through the
sheath, a 5 Fr. Omni I catheter was used to catheterize the aorta. A wire
was negotiated into the occluded left external iliac artery. From the
left sheath, the wire was snared and brought out of the patient by the
left side.
A catheter was then placed from the left sheath and a wire was placed
across the occluded segment of the left iliac artery into the aorta. A
wire was also placed from the right side into the aorta.
The decision was made to treat the occluded segment of the left common
iliac artery.
A balloon was placed into the right common iliac artery as protection and
a 8 mm-38 mm covered stent was then deployed in the left common iliac
artery. (1st stent) Angiogram revealed excellent flow through the stent graft.
However, there is thrombus seen in the distal portion of the stent.
A 10 mm-25 mm stent was then placed into the external iliac artery (2nd stent)which
treated the stenosis adequately. There was a severe stenosis of the right
external iliac artery that was also treated with 8 mm-17 mm stent. (3rd stent)Post stenting, an aortogram was performed. The aortogram revealed a large
plaque superior to the left common iliac stent.
The decision was made to place stents simultaneously into the iliac
arteries.
Over wires, two 8 mm wallstents were placed into the aorta extending into
the iliac arteries bilaterally(4th stent). Both stents were deployed simultaneously.
However, after the stents were deployed both stents migrated in a
cephalad manner into the aorta.
Multiple attempts were made to retrieve these stents but these were
unsuccessful.
The decision was then made to capture the stents via a 10 mm stents and 0
wires, two 10 mm-40 mm stent wall stent was then deployed into the
previously placed stent in the aorta and the aortic stent extending into
the iliac arteries. Post procedure, there is no residual gradient.
The patient's left lower extremity was evaluated and this showed an
occluded distal SFA. There was a short segment occlusion with
reconstitution of the popliteal artery. The popliteal artery is
continuous to the trifurcation and patient has a two vessel run-off.
IMPRESSION: Complete occlusion of the left iliac artery that was treated
with a covered stent.
However, and to treat the proximal portion of the stenosis the stents
migrated into the aorta and the entire distal aorta had to be structured
with stents.
Occluded distal left SFA.
Patent below the knee popliteal artery with a proximal run-off.
 
Last edited:
If i'm reading this right I came up with 4
75960x4
37205
37206x3

bilateral common iliacs and looks like bilateral external iliacs
initial stent was in the left common, then one in the external, then the right external and then the aorta into both iliacs
what were you thinking?
 
i'm running this scenario by the IVR phys. that I work for to get his thoughts also:)
 
i'm wondering if the left is a non-selective (36200) and the access from the right to the left external would be a 2nd order 36246? they punctured the right fem., then the wire was negotiated to the left external iliac.

I'm also questioning the stents. according to the Interventional Rad. coder, if common iliac and external iliacs are stented, that it's a stent for each. but on the left it kind of sounds like the left external iliac stent was used to treat the thrombus in the common iliac stent...so i'm wondering if that should just be one. Then 2 on the right for the common and external iliacs.

your thoughts?
 
Last edited:
From rigth to left the guidewire is only advanced, we only code for cath advancement

I dont have any idea about stents, I am getting only 4 stents
 
Hello Mindy:

I have illustrated the 4 stents, thats of my thoughts

Shirleybala said:
Hello:

How many stents I have to code for the below report,confusing please help.

Aortogram, left lower extremity angiogram, iliac stenting and aortic
stenting.
After obtaining informed consent, the patient was placed on the x-ray
table. Using ultrasound guidance, the left common femoral artery was
punctured and a 6 Fr. sheath was placed through a wire into the common
femoral artery. Angiogram revealed occlusion of the left common iliac
artery.
A wire was placed into the iliac artery but this appeared to be in a
false lumen.
The patient's right groin was prepped and draped in sterile fashion.
Using ultrasound guidance, the right common femoral artery was punctured
and a 6 Fr. sheath was placed into the common femoral artery. Through the
sheath, a 5 Fr. Omni I catheter was used to catheterize the aorta. A wire
was negotiated into the occluded left external iliac artery. From the
left sheath, the wire was snared and brought out of the patient by the
left side.
A catheter was then placed from the left sheath and a wire was placed
across the occluded segment of the left iliac artery into the aorta. A
wire was also placed from the right side into the aorta.
The decision was made to treat the occluded segment of the left common
iliac artery.
A balloon was placed into the right common iliac artery as protection and
a 8 mm-38 mm covered stent was then deployed in the left common iliac
artery. (1st stent) Angiogram revealed excellent flow through the stent graft.
However, there is thrombus seen in the distal portion of the stent.
A 10 mm-25 mm stent was then placed into the external iliac artery (2nd stent)which
treated the stenosis adequately. There was a severe stenosis of the right
external iliac artery that was also treated with 8 mm-17 mm stent. (3rd stent)Post stenting, an aortogram was performed. The aortogram revealed a large
plaque superior to the left common iliac stent.
The decision was made to place stents simultaneously into the iliac
arteries.
Over wires, two 8 mm wallstents were placed into the aorta extending into
the iliac arteries bilaterally(4th stent). Both stents were deployed simultaneously.
However, after the stents were deployed both stents migrated in a
cephalad manner into the aorta.
Multiple attempts were made to retrieve these stents but these were
unsuccessful.
The decision was then made to capture the stents via a 10 mm stents and 0
wires, two 10 mm-40 mm stent wall stent was then deployed into the
previously placed stent in the aorta and the aortic stent extending into
the iliac arteries. Post procedure, there is no residual gradient.
The patient's left lower extremity was evaluated and this showed an
occluded distal SFA. There was a short segment occlusion with
reconstitution of the popliteal artery. The popliteal artery is
continuous to the trifurcation and patient has a two vessel run-off.
IMPRESSION: Complete occlusion of the left iliac artery that was treated
with a covered stent.
However, and to treat the proximal portion of the stenosis the stents
migrated into the aorta and the entire distal aorta had to be structured
with stents.
Occluded distal left SFA.
Patent below the knee popliteal artery with a proximal run-off.
Click to expand...
 
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