I keep getting myself confused on coding the peripheral with runoff and second order, anyone please help to correctly code this..


PROCEDURE PERFORMED:
1. Serial abdominal aortography.
2. Peripheral angiography with runoff to both legs from the distal abdominal
aorta.
3. Moderate sedation.
4. Ultrasound for vascular access of the right radial artery.
5. Second order placement from the left common femoral artery to the right
common femoral artery with the sheath.
6. Balloon angioplasty and CSI atherectomy of the right distal SFA using a 2.0
burr at 60,000 and 80,000 RPM, CSI atherectomy catheter as well as a balloon
angioplasty with drug-coated balloon, 5.0 Lutonix, up to 12 atmospheres for 2
minutes.
7. MynxGrip was placed in left femoral arteriotomy at the end the case with
hemostasis. Wristband placed across right radial arteriotomy at the end the
case with hemostasis.
8. Supervision and interpretation of above.

INDICATIONS:
The patient is a 72-year-old female with worsening bilateral leg pain, right
worse in the left, here for possible peripheral angiography with possible
balloon angioplasty, stent placement, atherectomy as well. Informed witnessed
signed consent placed in the patient's medical record. The patient understood
the risks, benefits, alternatives, procedure, and wished to proceed. Risks
include, but are not limited to stroke, myocardial infarction, renal failure,
bleeding, limb loss, and death.

DESCRIPTION OF PROCEDURE:
The patient was brought to the cardiac catheterization laboratory in the
fasting state. Right wrist, both groins were prepped and draped in sterile
fashion. 2% lidocaine was infused in right wrist area for local anesthesia.
Using modified Seldinger technique, micropuncture kit and ultrasound for
vascular access. 6-French side-arm sheath was placed in the patient's right
radial artery. Next, I placed a long pigtail catheter at the level of the
distal abdominal aorta through the wrist. Distal abdominal aortography was
performed. Next, runoff to the feet was performed with digital subtraction.
Next, I did selective angiography of the right leg using the same pigtail
catheter and digital subtraction. Next, I went to intervention. The left
inguinal area was anesthetized with 2% lidocaine. Next, a 6-French side-arm
sheath was successfully placed in the patient's left femoral artery using a


Destination 45 cm 6-French sheath placed from the contralateral left femoral
artery all the way to the right common femoral artery, second order. Next, I
initially used Advantage wire for sheath placement. This was removed. A
Viper
wire was placed in the distal popliteal artery. Next, I proceeded with CSI
atherectomy with heparin used during the case. ACT greater than 250 seconds.
CSI atherectomy was performed at 60,000 and 80,000 RPM's. Next, I performed
balloon angioplasty using a 5.0 Lutonix balloon for 2 minutes at 12
atmospheres. Final angiography demonstrated excellent flow. No evidence of
edge dissection or distal thrombus. There was good flow all the way to the
ankle of the right leg.