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Peripheral atherectomy and angioplasty

  1. #1
    Default Peripheral atherectomy and angioplasty
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    Procedures Performed:
    R femoral angiography with S&I
    Balloon dilatation to the distal SFA
    Balloon dilatation to the popliteal artery
    Suboptimal balloon result with Fox Hollow atherectomy of the distal SFA

    Report as follows:
    Attempt to go through the right common femoral with antegrade stick unsuccessful given to fat tissue. Went thru the L groin, retrograde stick with a crossover using rim catheter with a glide wire. The glide was placed in the distal SFA and the rim catheter advanced and using Amplatz extra stiff placed a sheath crossed over to the proximal RSFA. With wires pushed into the distal vessel and reconstituted the distal SFA which was 100% stenosed with collaterals. After transcatheter going with a filter wire, spider placed distally distal to the popliteal in the peroneal tibial trunk and deployed successfully. We started with a 2x40 mm balloon and with multiple dilatation was obtained. Using a Fox atherectomy device, multiple rotational atherectomy was done in the distal SFA. After looking at the picture, a second 2.5 balloon and finally a 5x14 cm balloon was placed and inflated to 8 atm's for final dication. Final results showed no proximal distal dissection, TIMI III flow and minimal residual stenosis.

    Can I bill:
    36247 L Popliteal
    35474 LSFA
    35493 LSFA

    Any thoughts? Can peripheral atherectomy and angioplasty be billed together? Is this dependent on the payor? If so, which ones?

    Thanks for any insight. MJ

  2. Default
    In this case I would only code the atherectomy as far as the intervention goes. Not the angioplasty. I dont see anywhere in the report that says Angioplasty was suboptimal.

    The rest of your codes look good.

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