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Thread: Stents

  1. #1

    Default Stents

    AAPC: Back to School

    How many stents I have to code for the below report,confusing please help.

    Aortogram, left lower extremity angiogram, iliac stenting and aortic
    After obtaining informed consent, the patient was placed on the x-ray
    table. Using ultrasound guidance, the left common femoral artery was
    punctured and a 6 Fr. sheath was placed through a wire into the common
    femoral artery. Angiogram revealed occlusion of the left common iliac
    A wire was placed into the iliac artery but this appeared to be in a
    false lumen.
    The patient's right groin was prepped and draped in sterile fashion.
    Using ultrasound guidance, the right common femoral artery was punctured
    and a 6 Fr. sheath was placed into the common femoral artery. Through the
    sheath, a 5 Fr. Omni I catheter was used to catheterize the aorta. A wire
    was negotiated into the occluded left external iliac artery. From the
    left sheath, the wire was snared and brought out of the patient by the
    left side.
    A catheter was then placed from the left sheath and a wire was placed
    across the occluded segment of the left iliac artery into the aorta. A
    wire was also placed from the right side into the aorta.
    The decision was made to treat the occluded segment of the left common
    iliac artery.
    A balloon was placed into the right common iliac artery as protection and
    a 8 mm-38 mm covered stent was then deployed in the left common iliac
    (1st stent) Angiogram revealed excellent flow through the stent graft.
    However, there is thrombus seen in the distal portion of the stent.
    A 10 mm-25 mm stent was then placed into the external iliac artery (2nd stent)which
    treated the stenosis adequately. There was a severe stenosis of the right
    external iliac artery that was also treated with 8 mm-17 mm stent.
    (3rd stent)Post stenting, an aortogram was performed. The aortogram revealed a large
    plaque superior to the left common iliac stent.
    The decision was made to place stents simultaneously into the iliac
    Over wires, two 8 mm wallstents were placed into the aorta extending into
    the iliac arteries bilaterally
    (4th stent). Both stents were deployed simultaneously.
    However, after the stents were deployed both stents migrated in a
    cephalad manner into the aorta.
    Multiple attempts were made to retrieve these stents but these were
    The decision was then made to capture the stents via a 10 mm stents and 0
    wires, two 10 mm-40 mm stent wall stent was then deployed into the
    previously placed stent in the aorta and the aortic stent extending into
    the iliac arteries. Post procedure, there is no residual gradient.
    The patient's left lower extremity was evaluated and this showed an
    occluded distal SFA. There was a short segment occlusion with
    reconstitution of the popliteal artery. The popliteal artery is
    continuous to the trifurcation and patient has a two vessel run-off.
    IMPRESSION: Complete occlusion of the left iliac artery that was treated
    with a covered stent.
    However, and to treat the proximal portion of the stenosis the stents
    migrated into the aorta and the entire distal aorta had to be structured
    with stents.
    Occluded distal left SFA.
    Patent below the knee popliteal artery with a proximal run-off.
    Last edited by Shirleybala; 05-15-2009 at 03:31 AM.

  2. #2


    If i'm reading this right I came up with 4

    bilateral common iliacs and looks like bilateral external iliacs
    initial stent was in the left common, then one in the external, then the right external and then the aorta into both iliacs
    what were you thinking?

  3. #3


    I also got 4 stent codes only

  4. #4


    i'm running this scenario by the IVR phys. that I work for to get his thoughts also

  5. #5


    catheter codes 36200-50 am i right

  6. #6


    let me look at that...i was just counting stents

  7. #7


    I believe this is just 36200-50...

  8. #8


    Thankyou, i am coding on the way and putting the doubts and u are clearing on line
    Shirley CPC,CPC-H

  9. #9


    i'm wondering if the left is a non-selective (36200) and the access from the right to the left external would be a 2nd order 36246? they punctured the right fem., then the wire was negotiated to the left external iliac.

    I'm also questioning the stents. according to the Interventional Rad. coder, if common iliac and external iliacs are stented, that it's a stent for each. but on the left it kind of sounds like the left external iliac stent was used to treat the thrombus in the common iliac stent...so i'm wondering if that should just be one. Then 2 on the right for the common and external iliacs.

    your thoughts?
    Last edited by MLS2; 05-14-2009 at 07:48 AM.

  10. #10


    From rigth to left the guidewire is only advanced, we only code for cath advancement

    I dont have any idea about stents, I am getting only 4 stents

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