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More than your typical peripheral intervention

  1. #1
    Default More than your typical peripheral intervention
    Medical Coding Books
    Looking for guidance please. This wasn't your typical peripheral intervention. Wondering about any other ideas for coding besides the 37226. Can anything else be coded??? Do want to note that this WASN'T a diagnostic study. Patient came in specifically FOR the intervention.

    INDICATIONS FOR STUDIES: Peripheral arterial disease and claudication.


    STUDIES PERFORMED: Stenting of the left SFA and left common femoral artery using SAFARI technique.


    PROCEDURE DATA: Right groin was anesthetized with 2% Lidocaine. Subsequently, a 6-French sheath was inserted in the right femoral artery. After that, the 6-French crossover sheath was placed into the left common femoral artery. After that, the patient was changed to prone position. Then, the left popliteal fossa was sterilized. Under ultrasound guidance, the left popliteal artery was punctured. Subsequently, a 4-French sheath was placed.

    ANGIOGRAPHIC DATA: Left SFA is bluntly occluded at the origin due to CTO. It was reconstituted at the ductus canal.


    INTERVENTIONAL DATA: After the Heparin was given intravenously and therapeutic, the 4-French angled Glide catheter was assisted by a stiff angled Glidewire which initially failed to cross into the common femoral artery. After that, attempt to cross the lesion using SV 5 as well as an Astato wire was unsuccessful. Then, the lesion was eventually crossed using a straight Glidewire. After that, the Glide catheter was placed in the left common femoral artery. Subsequent angiogram showed it was in the lumen. Then, an 0.035 J-wire was introduced from the popliteal sheath into the left external iliac artery. Then, using a 6-French basket snare, the 035 J wire was snared into the 6-French sheath and exposed externally. Then, a 4.0 x 80 balloon was used to inflate the SFA and the common femoral artery at 10 atmospheres multiple times. After that, attempt to place the stent was unsuccessful due to the wire does not give enough support. Then, the vessel was rewired using an SV 5 wire with its tip into the popliteal artery sheath, and then the 0.035 wire was removed. After that, the 6 x 100 Zilver stent was placed. This was followed by another 6 x 100 Zilver stent to the proximal portion of the previous stent and then followed by a 7 x 100 Zilver stent was placed into the left SFA. Then, a repeat angiogram stated left common femoral artery has evidence of dissection. Then, another 7 x 80 Zilver stent was placed into the left common femoral artery. This was followed by balloon dilatation using 7 x 150 Armada balloon of the vessel and the stent at 4-6 atmospheres x4. After that, final angiography was obtained. The preprocedure stenosis 100%, postprocedure was 0%. There is excellent flow towards the left foot.


    At the end of the procedure, the right common femoral artery puncture site was sealed with Mynx. The left popliteal sheath was removed after the Protamine administration and a manual hold was performed. There was no complication at the end of the procedure.


    CONCLUSION:
    1. Successful PTA and stenting of the left common femoral artery and the left SFA using Safari technique with the left popliteal artery puncture using ultrasound guide, as well as right common femoral artery puncture technique.


    Can I do the 76942-26 at all for the ultrasound guidance? I don't typically see this done so I think maybe I can code for that as well as 37226.

    Thanks for any thoughts,
    Jessica CPC, CCC

  2. #2
    Default
    Quote Originally Posted by Jess1125 View Post
    Looking for guidance please. This wasn't your typical peripheral intervention. Wondering about any other ideas for coding besides the 37226. Can anything else be coded??? Do want to note that this WASN'T a diagnostic study. Patient came in specifically FOR the intervention.

    INDICATIONS FOR STUDIES: Peripheral arterial disease and claudication.


    STUDIES PERFORMED: Stenting of the left SFA and left common femoral artery using SAFARI technique.


    PROCEDURE DATA: Right groin was anesthetized with 2% Lidocaine. Subsequently, a 6-French sheath was inserted in the right femoral artery. After that, the 6-French crossover sheath was placed into the left common femoral artery. After that, the patient was changed to prone position. Then, the left popliteal fossa was sterilized. Under ultrasound guidance, the left popliteal artery was punctured. Subsequently, a 4-French sheath was placed.

    ANGIOGRAPHIC DATA: Left SFA is bluntly occluded at the origin due to CTO. It was reconstituted at the ductus canal.


    INTERVENTIONAL DATA: After the Heparin was given intravenously and therapeutic, the 4-French angled Glide catheter was assisted by a stiff angled Glidewire which initially failed to cross into the common femoral artery. After that, attempt to cross the lesion using SV 5 as well as an Astato wire was unsuccessful. Then, the lesion was eventually crossed using a straight Glidewire. After that, the Glide catheter was placed in the left common femoral artery. Subsequent angiogram showed it was in the lumen. Then, an 0.035 J-wire was introduced from the popliteal sheath into the left external iliac artery. Then, using a 6-French basket snare, the 035 J wire was snared into the 6-French sheath and exposed externally. Then, a 4.0 x 80 balloon was used to inflate the SFA and the common femoral artery at 10 atmospheres multiple times. After that, attempt to place the stent was unsuccessful due to the wire does not give enough support. Then, the vessel was rewired using an SV 5 wire with its tip into the popliteal artery sheath, and then the 0.035 wire was removed. After that, the 6 x 100 Zilver stent was placed. This was followed by another 6 x 100 Zilver stent to the proximal portion of the previous stent and then followed by a 7 x 100 Zilver stent was placed into the left SFA. Then, a repeat angiogram stated left common femoral artery has evidence of dissection. Then, another 7 x 80 Zilver stent was placed into the left common femoral artery. This was followed by balloon dilatation using 7 x 150 Armada balloon of the vessel and the stent at 4-6 atmospheres x4. After that, final angiography was obtained. The preprocedure stenosis 100%, postprocedure was 0%. There is excellent flow towards the left foot.


    At the end of the procedure, the right common femoral artery puncture site was sealed with Mynx. The left popliteal sheath was removed after the Protamine administration and a manual hold was performed. There was no complication at the end of the procedure.


    CONCLUSION:
    1. Successful PTA and stenting of the left common femoral artery and the left SFA using Safari technique with the left popliteal artery puncture using ultrasound guide, as well as right common femoral artery puncture technique.


    Can I do the 76942-26 at all for the ultrasound guidance? I don't typically see this done so I think maybe I can code for that as well as 37226.

    Thanks for any thoughts,
    Jessica CPC, CCC
    Yes you can bill for the ultrasound access. The maximum is two per day.
    HTH,
    Jim Pawloski, CIRCC

  3. Default
    Quote Originally Posted by Jess1125 View Post
    Looking for guidance please. This wasn't your typical peripheral intervention. Wondering about any other ideas for coding besides the 37226. Can anything else be coded??? Do want to note that this WASN'T a diagnostic study. Patient came in specifically FOR the intervention.

    INDICATIONS FOR STUDIES: Peripheral arterial disease and claudication.


    STUDIES PERFORMED: Stenting of the left SFA and left common femoral artery using SAFARI technique.


    PROCEDURE DATA: Right groin was anesthetized with 2% Lidocaine. Subsequently, a 6-French sheath was inserted in the right femoral artery. After that, the 6-French crossover sheath was placed into the left common femoral artery. After that, the patient was changed to prone position. Then, the left popliteal fossa was sterilized. Under ultrasound guidance, the left popliteal artery was punctured. Subsequently, a 4-French sheath was placed.

    ANGIOGRAPHIC DATA: Left SFA is bluntly occluded at the origin due to CTO. It was reconstituted at the ductus canal.


    INTERVENTIONAL DATA: After the Heparin was given intravenously and therapeutic, the 4-French angled Glide catheter was assisted by a stiff angled Glidewire which initially failed to cross into the common femoral artery. After that, attempt to cross the lesion using SV 5 as well as an Astato wire was unsuccessful. Then, the lesion was eventually crossed using a straight Glidewire. After that, the Glide catheter was placed in the left common femoral artery. Subsequent angiogram showed it was in the lumen. Then, an 0.035 J-wire was introduced from the popliteal sheath into the left external iliac artery. Then, using a 6-French basket snare, the 035 J wire was snared into the 6-French sheath and exposed externally. Then, a 4.0 x 80 balloon was used to inflate the SFA and the common femoral artery at 10 atmospheres multiple times. After that, attempt to place the stent was unsuccessful due to the wire does not give enough support. Then, the vessel was rewired using an SV 5 wire with its tip into the popliteal artery sheath, and then the 0.035 wire was removed. After that, the 6 x 100 Zilver stent was placed. This was followed by another 6 x 100 Zilver stent to the proximal portion of the previous stent and then followed by a 7 x 100 Zilver stent was placed into the left SFA. Then, a repeat angiogram stated left common femoral artery has evidence of dissection. Then, another 7 x 80 Zilver stent was placed into the left common femoral artery. This was followed by balloon dilatation using 7 x 150 Armada balloon of the vessel and the stent at 4-6 atmospheres x4. After that, final angiography was obtained. The preprocedure stenosis 100%, postprocedure was 0%. There is excellent flow towards the left foot.


    At the end of the procedure, the right common femoral artery puncture site was sealed with Mynx. The left popliteal sheath was removed after the Protamine administration and a manual hold was performed. There was no complication at the end of the procedure.


    CONCLUSION:
    1. Successful PTA and stenting of the left common femoral artery and the left SFA using Safari technique with the left popliteal artery puncture using ultrasound guide, as well as right common femoral artery puncture technique.


    Can I do the 76942-26 at all for the ultrasound guidance? I don't typically see this done so I think maybe I can code for that as well as 37226.

    Thanks for any thoughts,
    Jessica CPC, CCC
    Hey Jessica,
    check out code 76937. I read somewhere this was the correct code. Not sure see what you think.
    Theresa Dix CCS-P CPMA CCC ICDCT-CM

  4. #4
    Default
    OK, thanks for the responses.

    Jessica CPC, CCC

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