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endograft

  1. Default endograft
    Exam Training Packages
    Pls confirm my codes for the below procedure
    34900
    37205
    36245
    75954-26
    75960-26
    75726-26

    Procedure. Left renal artery stent placement. Left common iliac
    artery endograft as a joint radiological and surgical procedure.

    Anesthesia. General.

    Left renal artery angioplasty and stent placement.
    The exposed left common femoral artery was punctured with a
    19-gauge needle and a Newton J-wire advanced into the abdominal
    aorta to place a 9-French sheath. Through this an Omni flush
    catheter was positioned just above the renal arteries and the
    injection filmed in an RAO projection. An exchange was then made
    for a Sos II catheter and the renal artery origin engaged. A
    Terumo wire was advanced into the kidney and the Sos catheter
    pulled down. An .018 V18 wire was introduced and over this a
    Corinthian Palmaz balloon stent 6 mm x 18 mm was positioned in the
    renal artery orifice and expanded.

    Contrast injection at the end of the procedure demonstrated a good
    cosmetic result.
    Iliac stent placement.
    The pigtail catheter was pulled down to the distal aorta and a
    contrast injection performed. The origin of the left common iliac
    artery was marked. Over an Amplatz wire an AneuRx endograft 16 x
    85 was introduced and released in the common iliac artery across
    the aneurysm and the hypogastric artery origin which previously
    had been embolized. Contrast injection at the end of the
    procedure demonstrated complete exclusion of the common iliac
    artery aneurysm.

    Impression.
    Renal artery angioplasty and stent placement.

    Left common iliac artery endograft for a locked left common iliac
    artery aneurysm.
    Prabha CPC

  2. #2
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    Birmingham, Alabama
    Posts
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    Quote Originally Posted by prabha View Post
    Pls confirm my codes for the below procedure
    34900
    37205
    36245
    75954-26
    75960-26
    75726-26

    Procedure. Left renal artery stent placement. Left common iliac
    artery endograft as a joint radiological and surgical procedure.

    Anesthesia. General.

    Left renal artery angioplasty and stent placement.
    The exposed left common femoral artery was punctured with a
    19-gauge needle and a Newton J-wire advanced into the abdominal
    aorta to place a 9-French sheath. Through this an Omni flush
    catheter was positioned just above the renal arteries and the
    injection filmed in an RAO projection. An exchange was then made
    for a Sos II catheter and the renal artery origin engaged. A
    Terumo wire was advanced into the kidney and the Sos catheter
    pulled down. An .018 V18 wire was introduced and over this a
    Corinthian Palmaz balloon stent 6 mm x 18 mm was positioned in the
    renal artery orifice and expanded.

    Contrast injection at the end of the procedure demonstrated a good
    cosmetic result.
    Iliac stent placement.
    The pigtail catheter was pulled down to the distal aorta and a
    contrast injection performed. The origin of the left common iliac
    artery was marked. Over an Amplatz wire an AneuRx endograft 16 x
    85 was introduced and released in the common iliac artery across
    the aneurysm and the hypogastric artery origin which previously
    had been embolized. Contrast injection at the end of the
    procedure demonstrated complete exclusion of the common iliac
    artery aneurysm.

    Impression.
    Renal artery angioplasty and stent placement.

    Left common iliac artery endograft for a locked left common iliac
    artery aneurysm.
    I agree with all codes except the 75726 (for the renal angiography). This is selective only and the renal artery was not selected prior to the stent being placed. I would consider this an abdominal aortogram.
    I also do not see the open exposure documented so you are correct in not including that code. However, the physician may want to include this information. It is clear that the left common femoral was exposed but by whom?

    so, I would code:
    34900/75954 (26)
    37205/75960 (26,59)
    36245 (59)
    75625 (26,59)
    and possibly 34812 if the document is revised to include this.

    HTH
    Danny L. Peoples
    CIRCC,CPC

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