Wiki Vascular Catheterization CPT Help

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I do not have a lot of experience with vascular coding. I am looking for some help on how the following would be coded. I am thinking 36246-rt, 36247-rt ,37229-rt and 37225-rt.
Thank you in advance for any help.


POSTOPERATIVE DIAGNOSIS: Severe stenosis of the left popliteal artery,
severe stenosis of the left tibioperoneal trunk, occlusion of left anterior
tibial and posterior tibial artery, as well as stenosis of the right
popliteal artery and occlusion of the right anterior tibial artery.
OPERATION:
1) Ultrasound-guided access to the right common femoral artery.
2) Introduction of the catheter to terminal aorta.
3) Aortogram with runoff supervision and interpretation.
4) Selective catheterization of the left external iliac artery.
5) Left leg angiogram supervision and interpretation.
6) Selective catheterization of the left superficial femoral artery.
7) Selective angiogram of the left popliteal and peroneal artery.
8) Angioplasty of the left popliteal artery.
9) Atherectomy of the left popliteal artery.
10) Angioplasty of the left tibioperoneal trunk.
11) Atherectomy of the left tibioperoneal trunk.
12) Right lower extremity angiogram, supervision and interpretation.
13) Placement of AngioSeal device into rt common femoral artery
OPERATIVE DETAILS: The patient was brought to operating room #5 and placed
on the table in supine position. Anesthesia initiated conscious sedation.
Bilateral groins were prepped and draped in sterile fashion.
Ultrasound-guided access was obtained without any difficulty into the right
common femoral artery and a wire advanced under fluoroscopy guidance to the
terminal aorta, followed by placement of 5-French Pinnacle sheath and
Omniflush catheter to terminal aorta for performance of aortogram.
Aortogram was performed with injection of the contrast, interpretation as
following: Terminal aorta, bilateral common iliac, internal iliac and
external iliac artery appeared to be patent, with evidence of minimal
atherosclerotic disease.
At that point, decision was made to proceed with selective catheterization
of the left external iliac artery, that was successfully performed using
the angled Glidewire and a Glide catheter was advanced to the left side for
performance of left leg angiogram, that was performed with the injection of
the contrast, interpretation as following: The common femoral, profunda
artery, and superficial femoral artery appeared to be patent, with evidence
of some calcification along the wall, and there was evidence of a tight
stenotic lesion in the mid popliteal artery on the left side, and also
stenosis of the tibioperoneal trunk, and the runoff below-knee provided
with a patent peroneal artery. There was occlusion of the anterior tibial
and posterior tibial artery.
Considering the findings, decision was made to proceed with intervention of
the left lower extremity to alleviate the patient's symptoms. Five thousand
units of heparin was given to the patient. A 6-French Destination catheter
was positioned over the bifurcation of aorta over the stiff Glidewire.
Selective catheterization of the superficial femoral artery on the left
side was performed, and the Destination catheter was advanced to the mid
superficial femoral artery. Stenotic lesions from the popliteal artery and
tibioperoneal trunk were crossed using the Glidewire and a Seeker catheter
was advanced into the peroneal artery.
After that, 4mm distal protection SpiderFX catheter was advanced into the
peroneal artery and a basket was deployed, with intention of performing
manipulation of the wire of the basket. After that, atherectomy device was
used and multiple passes along the stenotic lesion of popliteal artery and
tibioperoneal trunk area were performed, that was followed with angioplasty
of the popliteal artery lesion using 5 x 60mm Lutonix balloon. Two minutes
inflation was held. Angioplasty of tibioperoneal trunk lesion was performed
using 3 x 60mm Coyote balloon.
Repeat angiogram showed there was complete resolution of stenotic lesions,
with brisk flow down to the foot. At that time, the catheter was withdrawn.
The SpiderFX was retrieved using the Seeker catheter.
An angiogram of the right lower extremity was performed as well,
interpretation as following: Common femoral, superficial femoral and
profunda artery appeared to be patent. Again, there is noticed stenotic
lesion in the mid popliteal artery and runoff below-knee provided by the
patent peroneal and posterior tibial artery. Puncture appeared to be
suitable for the placement of the AngioSeal device, and a 6-French
Angio-Seal device successfully deployed into the right common femoral
artery, with good hemostasis.
Sterile dressing and pressure dressing applied. The patient was
successfully transferred to Recovery Room in stable condition. The patient
tolerated procedure well. Procedure was uncomplicated. At the end of the
procedures, all the counts were correct.
 
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