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stent placement

  1. Default stent placement
    Medical Coding Books
    Pls confirm the catheter code for the below procedure.


    Catheter code should be 36216(brachial) or 36200(aorta)?

    Clinical history: Patient is an 82-year-old woman status post
    right CVA. Patient is status post inadvertent placement of left
    subclavian line into the left subclavian artery.

    The patient placed on the angiography table in the supine
    position. The right groin was prepped and draped in the usual
    sterile fashion. Utilizing a 21-gauge micropuncture needle the
    right common femoral artery was entered. Utilizing exchange
    techniques a 5-French vascular sheath was placed. An 5 french
    Omni flush catheter was advanced over the wire into the ascending
    aorta. Digital subtraction angiography of the thoracic aorta was
    performed. The right innominate artery was unremarkable in
    appearance. The right subclavian and right carotid branch where
    unremarkable where visualized. There is a dominant right
    vertebral artery. The left common carotid artery is unremarkable
    where visualized. The left subclavian artery was demonstrated. A
    central line catheter is seen entering into the left subclavian
    artery centrally. There is no significant filling of a vertebral
    artery. Vascular anatomy of the left subclavian was otherwise
    unremarkable. The Omni flush catheter was then exchanged for
    headhunter catheter which was used to successfully catheterize the
    left subclavian artery. Digital subtraction angiography was
    performed of the left subclavian artery. There is no significant
    filling of a vertebral artery. The headhunter catheter was
    advanced over Glidewire into the brachial artery. The Glidewire
    was then exchanged for an exchange length Amplatz wire. The
    headhunter catheter was removed over wire. The 5-French vascular
    sheath was exchanged for an 8-French vascular sheath. A 7 mm x 4
    cm covered stent (Fluency) was then advanced over the wire and
    positioned across the entry site of the 7-French central line
    catheter into the left subclavian. The central line catheter was
    removed and the fluency stent was deployed. Once the fluency was
    deployed the headhunter catheter was again advanced over wire into
    the subclavian artery. Digital subtraction angiography of the
    subclavian artery post deployment was performed. No extravasation
    of contrast material was identified. The stent was seen to cross
    the proximal subclavian including the region of the entry site of
    the prior catheter. The headhunter catheter was exchanged for an
    omni-flush catheter which was positioned in the ascending aorta.
    Final digital subtraction angiography of aortic arch was
    performed. No extravasation of contrast material was identified.
    Flow was seen throughout the subclavian artery and beyond the
    placement of the stent. The catheter was removed. The sheath was
    removed and 25 minutes of manual compression applied until
    hemostasis was obtained. The patient tolerated these procedures
    well per sterile dressing was applied.

    Impression: Successful deployment of 7 mm x 4 cm covered fluency
    stent within the subclavian artery covering the entry point of a
    7-French central line. Post deployment there was no extravasation
    of contrast material. Flow was seen to occur through the lfet
    subclavian artery into the brachial artery.
    Prabha CPC

  2. #2
    Cath code 36215 as cath wasn't advanced beyond L subclav. to L. brachial artery. Also can code 75710 for DSA prior to intervention.

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