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Peripheral Procedures..Second guessing myself..

  1. Default Peripheral Procedures..Second guessing myself..
    Medical Coding Books
    I am slowing getting there with these procedures, but am still having a little trouble. need you guys help!! Please and Thanks!! I don't know why I am having such a hard time grasping this, I do all right when it is part of any procedure!! go figure.

    Distal Aortogram with bilateral runoff;
    Selective angiography of left common femoral artery
    selective angiography of left superficial femoral artery
    selective angiography of right common femoral artery

    The patient underwent 6 french sheath placement in the right common femoral artery with a mild amount of difficulty. We took a Wholey wire over a pigtail catheter placement to the distal aorta and distal aortagram with bilateral lower extremity runoff was performed.

    right common iliac artery was widely patent
    right external iliac artery was widely patent
    right internal iliac artery was widely patent
    right common femoral artery was widely patent
    left common iliac artery had 30% proximal stenosis
    left external iliac artery was widely patent
    left internal iliac artery was widely patent
    left common femoral artery was widely patent

    We took an IMA catheter and the Wholey wire and we went down into the bifurcation. WE were able to take the IMA catheter down into the left common femoral artery for angiography, as well as left superficial femoral artery to complete the angiography. The completion of lower extremity angiography demonstrated. The left superficial femoral artery was widely patent. Left profundus femoral artery widely patent. Left popliteal trunk intact and patent. The left posterior tibial artery has in-line flow to the foot. The left peroneal artery has a functioning occluded proximally at the left anterior tibial artery 100% proximal occlusion with short CPO noted.

    The catheter and wire were removed from the body, and next angiography was performed to the right lower extremity via the right common femoral artery. the right common femoral artery selective angiography demonstrating widely patent vessel. runoff to the right superficial femoral artery shows that it was widely patent.

    right popliteal trunk was patent and intact. next, the right anterior tibial artery short CTO occlusion, right peroneal artery functionally occluded in the mid portion.

    next right posterior tibial artery functionally occluded proximally.

    recommendation here would be walking therapy for the left lower extremity. patient needs recascularization to the right lower extremity.. ther was no in-line flow here by any of the infrapopliteal vessels.

    I am not sure if my aortagram will be 75625, 75716?? My others codes will I need a 36246 or use the 75774 X ??
    My mind is shot this afternoon. Taking it home to work in the peace and quiet!!

    Thanks again,
    Beverly, CPC, CIMA

  2. #2
    Smile
    Quote Originally Posted by bevann0402@bellsouth.net View Post
    I am slowing getting there with these procedures, but am still having a little trouble. need you guys help!! Please and Thanks!! I don't know why I am having such a hard time grasping this, I do all right when it is part of any procedure!! go figure.

    Distal Aortogram with bilateral runoff;
    Selective angiography of left common femoral artery
    selective angiography of left superficial femoral artery
    selective angiography of right common femoral artery

    The patient underwent 6 french sheath placement in the right common femoral artery with a mild amount of difficulty. We took a Wholey wire over a pigtail catheter placement to the distal aorta and distal aortagram with bilateral lower extremity runoff was performed.

    right common iliac artery was widely patent
    right external iliac artery was widely patent
    right internal iliac artery was widely patent
    right common femoral artery was widely patent
    left common iliac artery had 30% proximal stenosis
    left external iliac artery was widely patent
    left internal iliac artery was widely patent
    left common femoral artery was widely patent

    We took an IMA catheter and the Wholey wire and we went down into the bifurcation. WE were able to take the IMA catheter down into the left common femoral artery for angiography, as well as left superficial femoral artery to complete the angiography. The completion of lower extremity angiography demonstrated. The left superficial femoral artery was widely patent. Left profundus femoral artery widely patent. Left popliteal trunk intact and patent. The left posterior tibial artery has in-line flow to the foot. The left peroneal artery has a functioning occluded proximally at the left anterior tibial artery 100% proximal occlusion with short CPO noted.

    The catheter and wire were removed from the body, and next angiography was performed to the right lower extremity via the right common femoral artery. the right common femoral artery selective angiography demonstrating widely patent vessel. runoff to the right superficial femoral artery shows that it was widely patent.

    right popliteal trunk was patent and intact. next, the right anterior tibial artery short CTO occlusion, right peroneal artery functionally occluded in the mid portion.

    next right posterior tibial artery functionally occluded proximally.

    recommendation here would be walking therapy for the left lower extremity. patient needs recascularization to the right lower extremity.. ther was no in-line flow here by any of the infrapopliteal vessels.

    I am not sure if my aortagram will be 75625, 75716?? My others codes will I need a 36246 or use the 75774 X ??
    My mind is shot this afternoon. Taking it home to work in the peace and quiet!!

    Thanks again,
    Beverly, CPC, CIMA
    I'll make it easier for you (I hope). There is not a diagnostic aortogram, placing the catheter in the distal aorta does not count, so 75625 is out. Catheter went to the lt SFA, so code 36247, and both legs were imaged, so 75716. No 75774's on this one.
    Thanks,
    Jim Pawloski, CIRCC

  3. Default
    Thanks so much Jim. Sometimes I need a quiet place in order to do these because our office is so loud and busy to the point you can't hear yourself think. LOL

    Re-reading the report, I see where I made my mistake in thinking I could code for the aortogram. I also see where my mistake was in selecting the 36246 instead of the 36547. I didn't come far enough down the leg (plus I missed that part even though I typed it!)

    Only one right was the 75716!!LOL

    It is slowly making sense. I really appreciate your response.

    Thanks again!!
    Beverly, CPC, CIMC

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