ljones1216
Contributor
Can I please get assistance with the CPT code(s)?
Procedures Performed (detailed):
Selective left subclavian angiography
PTA and successful stenting of proximal left subclavian artery with 7 x 29 mm VBX covered stent
Post dilation with 10 mm balloon proximally
Type of Anesthesia:
Moderate Sedation
Procedure Findings:
Selective left subclavian angiography revealed 99% stenosis and a heavily calcified segment of the proximal left subclavian artery. After stenting and post dilation there is 0% residual stenosis with brisk distal flow and no compromise of the vertebral artery or LIMA graft
Procedure Description:
The patient was brought to the hybrid OR in a fasting state. A timeout was performed and conscious sedation was administered. Personally supervised the nurse administering sedation for greater than 15 minutes and the entire duration of the procedure. The patient was prepped and draped in the usual sterile fashion. Under ultrasound guidance the right common femoral artery was punctured above the takeoff of the right to left femorofemoral bypass with a micropuncture needle. A 4 French dilator was inserted and exchanged for a 035 Rosen wire. The arteriotomy was sequentially dilated with a 6 French sheath and then a 7 French sheath. A 7 French 90 cm shuttle sheath was then advanced with some difficulty up into the proximal descending thoracic aorta. The patient was systemically heparinized. Through the shuttle sheath the left subclavian was engaged with a 5 French Vert catheter. A selective angiogram was performed confirming a very severe 99% stenosis of the proximal left subclavian. Attempts were made to wire through the vert catheter with an 035 Glidewire advantage, and 018 V18, and an 014 Ironman wire. All these attempts were unsuccessful due to lack of support. Next a CXI angled support catheter was used to engage the subclavian and direct a V 18 wire through the lesion successfully. The CXI catheter was advanced distally for extra-support as well as the V 18 wire. Balloon angioplasty was performed with a 4.0 x 20 mm balloon and then a 6.0 x 40 mm balloon. The lesion was then stented with a 7.0 x 29 mm VBX covered stent deployed at 14 atm. The proximal portion of the stent was then postdilated with a 10 x 20 mm balloon inflated to 10 atm. Completion angiography revealed an excellent angiographic result with less than 10% residual stenosis within the stented segment, no evidence of flow-limiting dissection, perforation, or other complication. Both the proximal and distal edges of the stent appeared to be completely opposed. This was thought to be an excellent result. The shuttle sheath was then withdrawn and exchanged for a short 7 French sheath. Right femoral arteriogram revealed significant calcific disease within the right femoral system. A an attempt at minx closure was performed but failed due to the balloon popping. Manual pressure was held.
I'm coming up with 37236 for the subclavian stent
Procedures Performed (detailed):
Selective left subclavian angiography
PTA and successful stenting of proximal left subclavian artery with 7 x 29 mm VBX covered stent
Post dilation with 10 mm balloon proximally
Type of Anesthesia:
Moderate Sedation
Procedure Findings:
Selective left subclavian angiography revealed 99% stenosis and a heavily calcified segment of the proximal left subclavian artery. After stenting and post dilation there is 0% residual stenosis with brisk distal flow and no compromise of the vertebral artery or LIMA graft
Procedure Description:
The patient was brought to the hybrid OR in a fasting state. A timeout was performed and conscious sedation was administered. Personally supervised the nurse administering sedation for greater than 15 minutes and the entire duration of the procedure. The patient was prepped and draped in the usual sterile fashion. Under ultrasound guidance the right common femoral artery was punctured above the takeoff of the right to left femorofemoral bypass with a micropuncture needle. A 4 French dilator was inserted and exchanged for a 035 Rosen wire. The arteriotomy was sequentially dilated with a 6 French sheath and then a 7 French sheath. A 7 French 90 cm shuttle sheath was then advanced with some difficulty up into the proximal descending thoracic aorta. The patient was systemically heparinized. Through the shuttle sheath the left subclavian was engaged with a 5 French Vert catheter. A selective angiogram was performed confirming a very severe 99% stenosis of the proximal left subclavian. Attempts were made to wire through the vert catheter with an 035 Glidewire advantage, and 018 V18, and an 014 Ironman wire. All these attempts were unsuccessful due to lack of support. Next a CXI angled support catheter was used to engage the subclavian and direct a V 18 wire through the lesion successfully. The CXI catheter was advanced distally for extra-support as well as the V 18 wire. Balloon angioplasty was performed with a 4.0 x 20 mm balloon and then a 6.0 x 40 mm balloon. The lesion was then stented with a 7.0 x 29 mm VBX covered stent deployed at 14 atm. The proximal portion of the stent was then postdilated with a 10 x 20 mm balloon inflated to 10 atm. Completion angiography revealed an excellent angiographic result with less than 10% residual stenosis within the stented segment, no evidence of flow-limiting dissection, perforation, or other complication. Both the proximal and distal edges of the stent appeared to be completely opposed. This was thought to be an excellent result. The shuttle sheath was then withdrawn and exchanged for a short 7 French sheath. Right femoral arteriogram revealed significant calcific disease within the right femoral system. A an attempt at minx closure was performed but failed due to the balloon popping. Manual pressure was held.
I'm coming up with 37236 for the subclavian stent