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Thread: brachial artery angioplasty

  1. #1

    Default brachial artery angioplasty

    Kindly confirm my codes,

    35475
    36120
    75962-26
    75710-2659
    Left Upper Extremity Arteriogram:
    Clinical History: 77-year-old male with end-stage renal disease on
    hemodialysis with a left upper extremity brachiocephalic
    hemodialysis AV fistula with steal syndrome status post AV
    fistulagraphy and left upper extremity arteriography demonstrating
    stenoses within the axillary artery and the brachial artery just
    beyond the AV anastomosis with percutaneous angioplasty of the
    axillary artery stenosis on 06/28/2010.
    patient presents for left upper extremity arteriography
    and percutaneous angioplasty of the brachial artery stenosis.

    Procedure and Findings:
    The left upper extremity was prepped and draped in the usual
    sterile fashion. After the administration of local anesthesia and
    under ultrasound guidance, access into the mid upper arm brachial
    artery was obtained with a 21-gauge micropuncture set in a
    retrograde fashion. A Bentson wire was advanced through the
    transition dilator which was exchanged for a 4-French vascular
    sheath.

    A 4-French Berenstein catheter was then advanced over the wire and
    position within the brachial artery just central to the AV
    anastomosis of the brachiocephalic AV fistula. A gentle injection
    of contrast was then performed confirming good positioning of the
    catheter just central to the AV anastomosis and demonstrating the
    brachial artery distal to the AV anastomosis.

    A straight glide wire was advanced through the Berenstein catheter
    and the catheter and Glidewire were used to gently cross the known
    high grade stenosis within the mid brachial artery just beyond the
    level of the AV anastomosis. A gentle injection of contrast
    confirmed good positioning of the distal tip of the catheter
    within the distal brachial artery beyond the AV anastomosis and a
    focal stenosis.

    An 014 wire was advanced through the catheter and down the ulnar
    artery.

    A pullback arteriogram with compression of the AV fistula outflow
    vein was then performed which demonstrated the focal high-grade
    stenosis of the mid brachial artery just distal to the AV
    anastomosis. The Berenstein catheter was then readvanced over the
    wire and positioned within the distal brachial artery.

    A distal left upper extremity arteriogram, utilizing digital
    subtraction angiography, was then performed.
    This demonstrated a focal, a mild, stenosis within the distal
    brachial artery likely related to spasm. The distal brachial
    artery was otherwise widely patent. The inter-osseous artery was
    widely patent. The ulnar artery was widely patent to the level of
    the wrist. The radial artery was not identified. The deep and
    superficial palmar arch were widely patent. The metacarpal
    digital arteries, the common digital arteries, the proper digital
    arteries, the radialis indicis artery appeared widely patent. The
    princeps pollicis artery was not identified.

    The indwelling Berenstein catheter was then removed over the 014
    wire. 30 mg of intra-arterial papaverine and 1 mL of normal
    saline was then administered via the indwelling sheath.

    Serial dilatation of the focal, high-grade, stenosis within the
    mid brachial artery was then performed with a 4 mm x 4 cm
    angioplasty balloon.

    The angioplasty balloon was then exchanged for the 4-French
    Berenstein catheter which was positioned within the brachial
    artery just central to the AV anastomosis.

    A post intervention left upper extremity arteriogram, utilizing
    digital angiography, was then performed via the indwelling
    catheter. This demonstrated a good result with white luminal
    patency of the mid brachial artery. A focal, moderate on the
    stenosis in the distal brachial artery was identified likely
    secondary to spasm.

    The Berenstein catheter was then advanced beyond the AV
    anastomosis into the mid brachial artery. An additional 30 mg of
    intra-arterial papaverine in 1 mL of normal saline was
    administered through the indwelling catheter. The indwelling
    catheter was then removed.

    Percutaneous submaximal balloon inflation angioplasty of the focal
    area of spasm within the distal brachial artery was then performed
    with a 4 mm x 4 cm angioplasty balloon. The angioplasty balloon
    was then removed and exchanged for the Berenstein catheter which
    was positioned within the brachial artery just central to the AV
    anastomosis of the AV fistula.

    A repeat left upper extremity arteriogram, with compression of the
    outflow vein of the AV fistula, was then performed via the
    indwelling catheter. This demonstrated a good result with white
    luminal patency of the mid and distal brachial artery. The
    angioplasty the focal high-grade stenosis within the mid brachial
    artery just beyond the AV anastomosis appeared widely patent. The
    focal area of spasm within the distal brachial artery appear
    widely patent.

    A final post-intervention left upper extremity arteriogram,
    utilizing digital subtraction angiography, was then performed.

    This demonstrated wide luminal patency of the mid and distal
    brachial artery. A high origin the radial artery was identified
    just central to the AV anastomosis and appear grossly patent. The
    ulnar artery and interosseous artery appeared widely patent with
    no filling defects identified to suggest distal embolization.

    The deep and superficial palmar arches and the digital arteries of
    the hand appeared widely patent with no filling defects to suggest
    distal embolization. The princeps pollicis artery is now
    identified and is widely patent. Reflux retrograde flow up the
    widely patent radial artery is identified.

    The catheter was then removed. After normalization of coagulation
    parameters the sheath was removed and hemostasis was obtained with
    direct manual compression.
    Impression:
    Left upper extremity arteriography demonstrating a focal
    high-grade stenosis within the mid brachial artery just distal to
    the AV anastomosis of the brachiocephalic fistula as described
    above. High origin of the radial artery originating from the
    brachial artery just central to the AV fistula AV anastomosis as
    described above.

    Successful treatment of the above described brachial artery
    stenosis with percutaneous angioplasty up to 4 mm as described
    above.
    Prabha CPC

  2. #2
    Join Date
    Apr 2007
    Posts
    77

    Default

    I would prefer the same set of codes....

    Thanks,
    Abdul Saleem CPC

  3. #3
    Join Date
    Apr 2007
    Location
    Birmingham, Alabama
    Posts
    886

    Default

    Quote Originally Posted by prabha View Post
    Kindly confirm my codes,

    35475
    36120
    75962-26
    75710-2659
    Left Upper Extremity Arteriogram:
    Clinical History: 77-year-old male with end-stage renal disease on
    hemodialysis with a left upper extremity brachiocephalic
    hemodialysis AV fistula with steal syndrome status post AV
    fistulagraphy and left upper extremity arteriography demonstrating
    stenoses within the axillary artery and the brachial artery just
    beyond the AV anastomosis with percutaneous angioplasty of the
    axillary artery stenosis on 06/28/2010.
    patient presents for left upper extremity arteriography
    and percutaneous angioplasty of the brachial artery stenosis.

    Procedure and Findings:
    The left upper extremity was prepped and draped in the usual
    sterile fashion. After the administration of local anesthesia and
    under ultrasound guidance, access into the mid upper arm brachial
    artery was obtained with a 21-gauge micropuncture set in a
    retrograde fashion. A Bentson wire was advanced through the
    transition dilator which was exchanged for a 4-French vascular
    sheath.

    A 4-French Berenstein catheter was then advanced over the wire and
    position within the brachial artery just central to the AV
    anastomosis of the brachiocephalic AV fistula. A gentle injection
    of contrast was then performed confirming good positioning of the
    catheter just central to the AV anastomosis and demonstrating the
    brachial artery distal to the AV anastomosis.

    A straight glide wire was advanced through the Berenstein catheter
    and the catheter and Glidewire were used to gently cross the known
    high grade stenosis within the mid brachial artery just beyond the
    level of the AV anastomosis. A gentle injection of contrast
    confirmed good positioning of the distal tip of the catheter
    within the distal brachial artery beyond the AV anastomosis and a
    focal stenosis.

    An 014 wire was advanced through the catheter and down the ulnar
    artery.

    A pullback arteriogram with compression of the AV fistula outflow
    vein was then performed which demonstrated the focal high-grade
    stenosis of the mid brachial artery just distal to the AV
    anastomosis. The Berenstein catheter was then readvanced over the
    wire and positioned within the distal brachial artery.

    A distal left upper extremity arteriogram, utilizing digital
    subtraction angiography, was then performed.
    This demonstrated a focal, a mild, stenosis within the distal
    brachial artery likely related to spasm. The distal brachial
    artery was otherwise widely patent. The inter-osseous artery was
    widely patent. The ulnar artery was widely patent to the level of
    the wrist. The radial artery was not identified. The deep and
    superficial palmar arch were widely patent. The metacarpal
    digital arteries, the common digital arteries, the proper digital
    arteries, the radialis indicis artery appeared widely patent. The
    princeps pollicis artery was not identified.

    The indwelling Berenstein catheter was then removed over the 014
    wire. 30 mg of intra-arterial papaverine and 1 mL of normal
    saline was then administered via the indwelling sheath.

    Serial dilatation of the focal, high-grade, stenosis within the
    mid brachial artery was then performed with a 4 mm x 4 cm
    angioplasty balloon.

    The angioplasty balloon was then exchanged for the 4-French
    Berenstein catheter which was positioned within the brachial
    artery just central to the AV anastomosis.

    A post intervention left upper extremity arteriogram, utilizing
    digital angiography, was then performed via the indwelling
    catheter. This demonstrated a good result with white luminal
    patency of the mid brachial artery. A focal, moderate on the
    stenosis in the distal brachial artery was identified likely
    secondary to spasm.

    The Berenstein catheter was then advanced beyond the AV
    anastomosis into the mid brachial artery. An additional 30 mg of
    intra-arterial papaverine in 1 mL of normal saline was
    administered through the indwelling catheter. The indwelling
    catheter was then removed.

    Percutaneous submaximal balloon inflation angioplasty of the focal
    area of spasm within the distal brachial artery was then performed
    with a 4 mm x 4 cm angioplasty balloon. The angioplasty balloon
    was then removed and exchanged for the Berenstein catheter which
    was positioned within the brachial artery just central to the AV
    anastomosis of the AV fistula.

    A repeat left upper extremity arteriogram, with compression of the
    outflow vein of the AV fistula, was then performed via the
    indwelling catheter. This demonstrated a good result with white
    luminal patency of the mid and distal brachial artery. The
    angioplasty the focal high-grade stenosis within the mid brachial
    artery just beyond the AV anastomosis appeared widely patent. The
    focal area of spasm within the distal brachial artery appear
    widely patent.

    A final post-intervention left upper extremity arteriogram,
    utilizing digital subtraction angiography, was then performed.

    This demonstrated wide luminal patency of the mid and distal
    brachial artery. A high origin the radial artery was identified
    just central to the AV anastomosis and appear grossly patent. The
    ulnar artery and interosseous artery appeared widely patent with
    no filling defects identified to suggest distal embolization.

    The deep and superficial palmar arches and the digital arteries of
    the hand appeared widely patent with no filling defects to suggest
    distal embolization. The princeps pollicis artery is now
    identified and is widely patent. Reflux retrograde flow up the
    widely patent radial artery is identified.

    The catheter was then removed. After normalization of coagulation
    parameters the sheath was removed and hemostasis was obtained with
    direct manual compression.
    Impression:
    Left upper extremity arteriography demonstrating a focal
    high-grade stenosis within the mid brachial artery just distal to
    the AV anastomosis of the brachiocephalic fistula as described
    above. High origin of the radial artery originating from the
    brachial artery just central to the AV fistula AV anastomosis as
    described above.

    Successful treatment of the above described brachial artery
    stenosis with percutaneous angioplasty up to 4 mm as described
    above.
    IMO, this is an AV fistulogram with angioplasty. I would code:
    35475/75962
    36147

    HTH
    Danny L. Peoples
    CIRCC,CPC

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