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Thread: Atherectomy and angioplasty help

  1. #1
    Join Date
    Apr 2007

    Default Atherectomy and angioplasty help

    AAPC: Back to School
    Hello all, Can I get someones expert advice on coding this report. I have shortend it alot just to show what he did. Should I code all three Atherectomies and all three Angioplasties? The thing is, it seems he always does these together because of sub-optimal results, so I feel they are adjunctive procedures, but in this report I feel it my be warrented. PLEASE what are your thoughts?

    Using an up and over catheter and an angled Glidewire
    we were able to manipulate the wire and the catheter over into the
    right common femoral artery. Previous aortograms were used for
    anatomy. A selective right lower extremity arteriogram was performed.
    This showed a patent common femoral, superficial femoral, profunda
    arteries. A stent in the proximal superficial femoral artery was
    patent without any evidence of narrowing. There was some narrowing in
    the distal superficial femoral artery in the 50% range at the
    adductor canal. The popliteal artery was then occluded just above the
    knee joint. It ended in several collaterals. Recanalization of the
    posterior tibial artery was seen likely several centimeters after the
    origin. Also seen was reconstitution of the anterior tibial artery
    several centimeters after the origin as well.
    Given her critical limb ischemia we felt trying to open her occlusion
    would be of her best interest. Intravenous Heparin was given.
    Activated clotting times were checked. A wire followed by a catheter
    was placed down into the proximal popliteal artery. A more selective
    right lower extremity arteriogram was performed just to get better
    visualization of the target vessel, the posterior tibial artery. We
    were then able to cross the occluded popliteal artery, tibioperoneal
    trunk, and proximal posterior tibial artery with a combination of an
    0.035 inch Glidewire and a QuickCross catheter. The wire was removed.
    Dye was injected into the QuickCross catheter to confirm intraluminal
    placement of the posterior tibial artery. Several instillations of
    intraarterial nitroglycerin were given to prevent vasospasm. I then
    exchanged for a smaller 0.014 inch wire. A Pathway Jetstream device
    was used for orbital atherectomy. The Pathway Jetstream device was
    then chosen performing a percutaneous atherectomy. Several passes
    were made with the blades down and then the blades up given a 3 mm.
    maximal luminal gain. Completion arteriogram showed essentially no
    flow or very stagnant flow through the treated artery but it did
    trickle down suggesting either distal vasospasm or maybe embolic
    debris. Prolonged angioplasty was then performed with a 3 mm. x 150
    cm. balloon. Completion arteriogram showed the same result. More
    nitroglycerin was instilled. We let a few minutes lapse and repeated
    injection. It now revealed that the popliteal artery now was open
    with nice inline flow into the tibioperoneal trunk and posterior
    tibial artery which made it all the way down to the ankle. A small
    area of extravasation was seen likely in the tibioperoneal trunk was
    fairly small and did not seem concerning or to be growing rapidly.
    Balloon angioplasty was then performed of the narrowing in the distal
    superficial femoral artery. A 4 mm. balloon was chosen. Completion
    arteriogram showed decent result throughout the entire leg without
    any evidence of embolization.

  2. #2
    Join Date
    Apr 2007
    Ann Arbor


    I posted a question just like your recently. Basically, a coder went to Dr. Z's conference, and he said that you code for the atherectomy, even if angioplasty is done before or after the atherectomy.

    I hope this answers your question,
    Jim Pawloski, CIRCC, R.T.(CV)

  3. #3


    To tell you the truth I looked at this several times yesterday but just didnt have the patience to read the whole report.

    But for issue of both an ather and plasty being done. The guideline is the only the most extensive service is performed and this means the ather. You can code all 3 atherectomies IF they were on separate vessles.

    Like I said I didnt read the report, but for example, if an ather/plasty was done on the left iliac, the right SFA and the left popliteal, then he is on three separate vessels and you would code for all 3 atherectomies.

    You should also be coding for all the diagnostic selective cath placements and angiographies if done during this same session to idenitfy the locations needing the ather/plasty

    If you dont have the Interventional Radiology Coder, I would suggest getting it. Includes the above guidance. Can't code peripheral vascular without it

  4. #4
    Join Date
    Apr 2007

    Default Atherectomy and Angioplasty Help

    Thank you both so much for taking the time to reply. I never bill for both but for some reason I was starting to falter with this report. You confirmed my gut instincts. Have a GREAT Holiday!

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