The TPA during the procedure is included in the thrombectomy, but the TPA infusion can be billed separately. Also the PTA can be billed.Can we code 37184 along with 37201 for the below report and also will the angioplasty be included in 37184 or should be coded seperately?
Left lower extremity angiogram, thrombolysis, thrombectomy and
After informed consent, patient's right groin was prepped and draped in
sterile fashion. Using ultrasound guidance the right common femoral
artery was punctured and a 5 French sheath was placed in the common
femoral artery. Through this sheath, 5 French Simmons 2 catheter was used
to catheterize the left common iliac artery. Left angiogram performed.
The aortic bifurcation is markedly steep. The common, internal and
external iliac arteries are patent. The left common femoral artery is
patent. The SFA is patent. The popliteal artery is occluded. No discrete
flow is seen. There is faint visualization of the anterior tibial artery.
Patient's left groin was prepped and draped in sterile fashion. Using,
ultrasound guidance, the left common femoral artery was puncture in
antegrade fashion and a 6 French sheath was placed in the common femoral
artery into the superficial femoral artery. Through this sheath, a 5
French Davis catheter used to catheterize the popliteal artery. A 5
French catheter was then passed over a wire into the anterior tibial
artery. The catheter was then removed and the entire below the knee
popliteal artery and the anterior tibial artery were then laced with 3 mg
of tPA. After pulsing of tPA, angiojet thrombectomy was performed. Post
thrombectomy, stenosis was uncovered in the popliteal artery just at the
knee joint and at the proximal anterior tibial artery.
The popliteal artery was then angioplastied with a 5 mm balloon and the
anterior tibial artery was then angioplastied with a 3'bd mm balloon.
Post procedure, there is still some residual thrombus. There is now faint
visualization of the tibioperoneal trunk.
n infusion catheter was then placed in the popliteal artery extending
into the anterior tibial artery. tPA infusion was initiated. The patient
will be reevaluated in the morning.
IMPRESSION: Complete occlusion of the below the knee popliteal artery
with the occlusion extending into trifurcation vessels.
Successful thrombolysis, thrombectomy angioplasty with restoration of
flow in the anterior tibial artery. tPA infusion will be started.
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