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Thread: Bilateral leg runoff/sfa angiogram,angioplasty and stenting

  1. #1
    Join Date
    Apr 2007
    Location
    Melbourne, Florida
    Posts
    125

    Default Bilateral leg runoff/sfa angiogram,angioplasty and stenting

    Promo: Code Books
    ANY HELP WOULD BE APPRECIATED IN CODING THE FOLLOWING:

    PROCEDURES PERFORMED:
    1. Bilateral leg runoff.
    2. Left superficial femoral artery angiogram.
    3. Left superficial femoral artery angioplasty.
    4. Left superficial femoral artery stenting.
    5. Infusion catheter placed for TPA to the distal left leg vessels.

    COMPLICATIONS: Emboli to the distal left leg vessels.

    WE CAME UP WITH
    36200-59
    75625-26
    36140
    75716-26-59
    FOR THE BILATTERAL RUNOFF

    35474 (PTA)
    75962-26 (S&I)
    37205 (STENT)
    75960-26 (S&I)
    Denise Gilrane-Pillow, CPB

  2. #2
    Join Date
    Apr 2007
    Location
    Columbus
    Posts
    13

    Default

    This is how I believe this should be coded
    36247- Lt SFA angiogram
    75774-26
    75716-26-59 - B/L lower extremity runoff
    It was not indicated that an Aortogram was done so I would not use 75625
    For your intervention codes
    35474- SFA angioplasty
    75962-26
    37205- Stent
    75960-26
    37201 Catheter placement for TPA
    75896-26
    * You can only use 37201 once during the TPA treatment, however you may use 75896-26 if follow-up angiogram is done later. If a thrombectomy is done following this you should use code(s) 37184-37186.
    I hope this helps.
    Last edited by crabby1; 01-07-2010 at 04:59 AM. Reason: added modifer on 75716-26 and corrected code

  3. #3
    Join Date
    Apr 2007
    Location
    Melbourne, Florida
    Posts
    125

    Thumbs up

    Thank you very much, I appreciate your explanation of code usage
    Denise Gilrane-Pillow, CPB

  4. #4
    Join Date
    Apr 2007
    Location
    Woodbridge, Virginia
    Posts
    69

    Default

    I agree with the above codes except for the following:

    My bundling programs show that 37205 and 37201 are bundled and can not be billed together. So whenever I have coded a stent (37205/75960-26) I have not coded the transcatheter therapy (37201/75896-26)

  5. #5

    Default

    do you have an actual report for this case?

  6. #6
    Join Date
    Apr 2007
    Location
    Melbourne, Florida
    Posts
    125

    Default Bilateral leg runoff

    HERE IS THE COPY OF THE 2 DAY PROCEDURE .. IT'S QUITE A BIT, THANK YOU FOR YOUR INTEREST.



    DATE OF PROCEDURE: 12/30/2009

    PREPROCEDURAL DIAGNOSIS: Intractable claudication with left superficial
    femoral artery chronic total occlusion.

    POSTPROCEDURAL DIAGNOSIS: Left superficial femoral artery chronic total
    occlusion, status post stenting with subsequent thrombus embolization to the
    distal vessels.

    PROCEDURES PERFORMED:
    1. Bilateral leg runoff.
    2. Left superficial femoral artery angiogram.
    3. Left superficial femoral artery angioplasty.
    4. Left superficial femoral artery stenting.
    5. Infusion catheter placed for TPA to the distal left leg vessels.

    COMPLICATIONS: Emboli to the distal left leg vessels.

    PROCEDURE DETAILS: Patient was prepped and draped in a sterile manner. A
    4-French short sheath was placed into the right femoral artery. Pigtail was
    placed into the aortoiliac junction. Angiogram demonstrated 100% occlusion of
    the SFA at the ostium to the distal 1/3 with mild collaterals coming from the
    left profunda. Subsequently a 4-French LIMA catheter was placed into the
    ostium of the left iliac and a stiff-angled glidewire was advanced into the
    profunda. The LIMA catheter was then advanced. The glidewire was then
    exchanged out for a stiff Amplatz wire. The LIMA catheter was exchanged out,
    and a 7-French Destination catheter was placed; was advanced across the horn
    of the aortoiliac junction into the left iliac. Thereafter, the angled
    glidewire and glide catheter were used to penetrate the chronic total
    occlusion and were able to advance into the ongoing SFA and subsequently into
    the popliteal.

    Thereafter, a 5 x 100 peripheral balloon was advanced and ballooned 3 times
    over the chronic total occlusion leaving multiple small dissections and a
    significant amount of thrombus in the mid SFA. Thereafter, a 7 x 150 Cordis
    Smart self-expanding stent was placed in the mid third of the SFA, covering
    the thrombus. Thereafter, a 7 x 60 mm Smart Control Nitinol stent was placed
    proximally to that. Thereafter, a 7 x 59 mm balloon expandable Palmaz Genesis
    stent was placed from the ostium of the SFA into the proximal SFA. There were
    residual 30% lesions that would have required post-stent dilatation; however,
    subsequent angiogram after stenting demonstrated thrombus in the distal
    vessels occluding the anterior tibialis, posterior tibialis and peroneal
    vessel.

    Thereafter, the LIMA catheter was placed back into the popliteal. An Amplatz
    was advanced into the popliteal. The Destination catheter was exchanged out
    for a short 7-French sheath. The LIMA catheter was then placed over the
    Amplatz wire and the Amplatz wire was exchanged out for a long Confianza wire.
    The LIMA catheter was then exchanged out for a Renegade infusion catheter
    which was placed into the distal popliteal. The Confianza was then removed and
    TPA was administered. During initial evaluation of the thrombus in the distal
    vessels, Integrilin was hung. Patient subsequently noted improvement in his
    left leg pain with TPA infusion. Patient will be admitted to the ICU for
    overnight infusion of Retavase.

    FINDINGS:
    1. Chronic total occlusion of the SFA status post angioplasty and stenting .
    2. Complication of distal embolization into the distal leg vessels involving
    the anterior tibialis, posterior tibialis and the peroneal vessel.
    3. Infusion catheter with Retavase for chemical thrombectomy along with
    Integrilin and heparin infusions.





    _________________________
    , MD


    Dictated by: MD





    DATE OF SERVICE: 12/31/2009

    PREPROCEDURE DIAGNOSES: Left distal vessel embolization and left superficial
    femoral artery stenting.

    POSTPROCEDURE DIAGNOSES: Distal vessel embolization with a residual mild clot
    involving the mid posterior tibialis artery.

    OPERATION/PROCEDURE: Superficial femoral artery angioplasty, left leg runoff
    and a posterior tibialis angioplasty.

    PROCEDURE PERFORMED BY: Dr. Aggarwal.

    ANESTHESIA: IV Versed and fentanyl with local lidocaine.

    COMPLICATIONS: None.

    FINDINGS: The patient was prepped and draped in a sterile manner. The short
    7-French sheath was exchanged out for a 7-French Destination using modified
    Seldinger technique. Left leg runoff demonstrated patent SFA with residual
    30% lesions in the prox and mid SFA and patent anterior tibialis and
    superficial perioneal artery. The mid posterior tibialis was occluded but the
    distal posterior tibialis was filled by collaterals from the other 2 vessels.
    A Magic Torque wire was placed after a glidewire was exchanged out. A
    6-French 100 mm balloon was used to inflate and post dilate the stents to a 0%
    residual. Thereafter, a Confianza wire was placed into the posterior tibialis
    and a 2.5 x 60 mm balloon was inflated over multiple times, using Integrelin
    and heparin. There was improvement in the vessel; however, there was still
    persistent clot despite extraction with a Quick-Cross and syringe suction.
    There remained 100% mid posterior tibialis obstruction measuring approximately
    10-15 mm in length. Nipride and nitroglycerin were injected through the
    Quick-Cross into the mid posterior tibialis with no avail. However, the
    patient was pain free and had distal constitution _____ collaterals.
    Therefore, no further intervention was done. The patient will be placed on
    Integrelin overnight.

    FINDINGS: Patent saphenous vein graft stents with post-stent ballooning and
    100% mid posterior tibialis with unsuccessful angioplasty.





    ,MD
    Denise Gilrane-Pillow, CPB

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