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Superior Mesenteric artery PTA and runoff

  1. Default Superior Mesenteric artery PTA and runoff
    Medical Coding Books
    Need a little help.

    Indication: Ischemic colitis, ischemic bowel, abnormal CTA finding with superior mesenteric artery of at least 70% stenosis. The patient was prepped according to protocol, 1% xylocaine injected locally. Initially, access was obtained with 6-french sheath followed by a 7-french sheath and we used a pigtail catheter to obtain an aortogram; 40mL were given with power injection. Then, we used a left internal mammary guiding catheter short and then engaged with the origin of the superior mesenteric artery. Spartacore wire was advanced across the lesion. We used 5.0 and 6.0 balloons to predilate the lesion, which continued to have significant recoil and then subsequently, we attempted to advance and 8.0 stent, but without success due to the guide mismatch. So we switched to an 8-french sheath, 8-french guiding catheter and we used an 8.0x 29 omnilink that was deployed at nominal and we flared up the proximal segment of it, which was placed appropriately through the origin of the superior mesenteric artery and with a small extension into the aorta. No immediate problems were noted and excellent flow after the procedure and resolution of stenosis from more than 90% pre to 0% afterwards. The patient was given heparin through the procedure, maintaining ACT more than 300. Angio-seal was deployed in the femoral artery.
    Carrie Sorensen, CPC

  2. #2
    Default
    Quote Originally Posted by csorensen21@yahoo.com View Post
    Need a little help.

    Indication: Ischemic colitis, ischemic bowel, abnormal CTA finding with superior mesenteric artery of at least 70% stenosis. The patient was prepped according to protocol, 1% xylocaine injected locally. Initially, access was obtained with 6-french sheath followed by a 7-french sheath and we used a pigtail catheter to obtain an aortogram; 40mL were given with power injection. Then, we used a left internal mammary guiding catheter short and then engaged with the origin of the superior mesenteric artery. Spartacore wire was advanced across the lesion. We used 5.0 and 6.0 balloons to predilate the lesion, which continued to have significant recoil and then subsequently, we attempted to advance and 8.0 stent, but without success due to the guide mismatch. So we switched to an 8-french sheath, 8-french guiding catheter and we used an 8.0x 29 omnilink that was deployed at nominal and we flared up the proximal segment of it, which was placed appropriately through the origin of the superior mesenteric artery and with a small extension into the aorta. No immediate problems were noted and excellent flow after the procedure and resolution of stenosis from more than 90% pre to 0% afterwards. The patient was given heparin through the procedure, maintaining ACT more than 300. Angio-seal was deployed in the femoral artery.
    To me, it does not look like a diagnostic study was performed, the diagnosis was from the CTA. So I would billed this 36245 and 37236.
    HTH,
    Jim Pawloski, CIRCC

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