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Angioplasty

  1. Default Angioplasty
    Medical Coding Books
    Can anyone suggest me the codes for the below procedure?

    STUDY: Bilateral common iliac angioplasty and stent placement, and left
    profunda femoris artery angioplasty.
    CLINICAL INDICATION: Profound ischemia involving left lower extremity
    status post attempted placement of aortoiliac stents.
    groins were prepped and draped in sterile fashion. The skin was
    anesthetized with 1% lidocaine. Contrast injection revealed patency of
    the left common iliac stent-graft. However, there was very sluggish flow
    with very poor inflow. High-grade stenosis involving the profunda
    femoris was identified.
    Attempts were made at selectively catheterizing the left iliac stent from
    the right femoral approach using a #5-French rim catheter, without
    success. Following this, attempts were made at selectively catheterizing
    the right common iliac artery from the left femoral approach, again
    without success, using both a #5-French rim catheter and a #5-French
    Simmons glide catheter. This was as the result of a preexisting
    retrograde dissection involving the distal abdominal aorta.
    Finally, #7-French sheaths were placed via both groins by upsizing the
    right and a 15-mm Amplatz loop snare used to snare a wire from the right
    common femoral artery placed in the descending thoracic aorta from the
    left lower approach. This allowed for withdrawal of a catheter into the
    left iliac stent-graft from the right femoral approach. Using this
    access, a 4 mm angioplasty was performed over a .018-inch wire of the
    proximal profunda femoris. There remained poor inflow. This information
    was discussed with Dr. Thompson, referring vascular surgeon.
    Decisions were made to perform bilateral common iliac artery angioplasty
    and stent placements. The descending thoracic aorta was selectively
    catheterized and .035-inch Amplatz superstiff wires placed. Free
    angioplasty with 6 mm angioplasty was performed. Following this, 10 mm
    in diameter x 39 mm in length stents were placed from the distal
    abdominal aorta to the common iliac arteries bilaterally. Additional
    extension with a 20-mm stent was placed to provide for excellent flow
    through the left common iliac stent-graft. Following the procedure, the
    catheter and sheaths were removed and pressure applied to both groins for
    one-half hour. There was excellent femoral pulse through the left common
    femoral artery at the completion of the procedure. The patient had a
    moderate proximal left thigh hematoma. There remained profound ischemia
    involving the left lower extremity below the knee. The patient was
    transferred to the Intensive Care Unit with generally improved left
    femoral pulse and no other significant change in her hemodynamic status.
    IMPRESSION: Status post bilateral aortoiliac stents and angioplasty with
    left profunda femoris angioplasty, as described above.
    Prabha CPC

  2. #2
    Location
    Birmingham, Alabama
    Posts
    890
    Default
    Quote Originally Posted by prabha View Post
    Can anyone suggest me the codes for the below procedure?

    STUDY: Bilateral common iliac angioplasty and stent placement, and left
    profunda femoris artery angioplasty.
    CLINICAL INDICATION: Profound ischemia involving left lower extremity
    status post attempted placement of aortoiliac stents.
    groins were prepped and draped in sterile fashion. The skin was
    anesthetized with 1% lidocaine. Contrast injection revealed patency of
    the left common iliac stent-graft. However, there was very sluggish flow
    with very poor inflow. High-grade stenosis involving the profunda
    femoris was identified.
    Attempts were made at selectively catheterizing the left iliac stent from
    the right femoral approach using a #5-French rim catheter, without
    success. Following this, attempts were made at selectively catheterizing
    the right common iliac artery from the left femoral approach, again
    without success, using both a #5-French rim catheter and a #5-French
    Simmons glide catheter. This was as the result of a preexisting
    retrograde dissection involving the distal abdominal aorta.
    Finally, #7-French sheaths were placed via both groins by upsizing the
    right and a 15-mm Amplatz loop snare used to snare a wire from the right
    common femoral artery placed in the descending thoracic aorta from the
    left lower approach. This allowed for withdrawal of a catheter into the
    left iliac stent-graft from the right femoral approach. Using this
    access, a 4 mm angioplasty was performed over a .018-inch wire of the
    proximal profunda femoris. There remained poor inflow
    . This information

    was discussed with Dr. Thompson, referring vascular surgeon.
    Decisions were made to perform bilateral common iliac artery angioplasty
    and stent placements. The descending thoracic aorta was selectively
    catheterized and .035-inch Amplatz superstiff wires placed. Free
    angioplasty with 6 mm angioplasty was performed. Following this, 10 mm
    in diameter x 39 mm in length stents were placed from the distal
    abdominal aorta to the common iliac arteries bilaterally. Additional
    extension with a 20-mm stent was placed to provide for excellent flow
    through the left common iliac stent-graft. Following the procedure, the
    catheter and sheaths were removed and pressure applied to both groins for
    one-half hour. There was excellent femoral pulse through the left common
    femoral artery at the completion of the procedure. The patient had a
    moderate proximal left thigh hematoma. There remained profound ischemia
    involving the left lower extremity below the knee. The patient was
    transferred to the Intensive Care Unit with generally improved left
    femoral pulse and no other significant change in her hemodynamic status.
    IMPRESSION: Status post bilateral aortoiliac stents and angioplasty with
    left profunda femoris angioplasty, as described above.

    The guidelines are that you can bill for angioplasty prior to stent placement as long as suboptimal results are documented. There is only one instance of this in the note. So...

    37205/75960
    37206/75960
    35474/75962
    36245
    36200-59 (catheter/access documentation could be clearer and may allow for higher order code)

    I see no documentation of images performed prior to intervention.
    HTH
    Danny L. Peoples
    CIRCC,CPC

  3. Default
    Thanks Danny.....
    Prabha CPC

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