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open vs. closed stent

  1. Default open vs. closed stent
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    Hope someone has some ideas on this one. I am just stumped. Doctor did a cut down on the Rt CFA access the vessel stent the common iliac with two stents and the crossed over and placed a stent in the proxmial Lt common iliac, ran the dye again and noticed a flap in the distal common iliac, could not pass the wire any further. Then percutaneously stuck the Lt CFA and placed the stent in the distal Lt common iliac.
    My question is I know that I can bill 37207 for the stents in the RT common iliac and 37208 for the stent in the proxmial Lt common iliac but can I bill 37205 for the percutaneous stent in the distal common iliac since it was a different access point or not because it was the same vessel>
    Thanks
    Lisa

  2. #2
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    Quote Originally Posted by lisammy View Post
    Hope someone has some ideas on this one. I am just stumped. Doctor did a cut down on the Rt CFA access the vessel stent the common iliac with two stents and the crossed over and placed a stent in the proxmial Lt common iliac, ran the dye again and noticed a flap in the distal common iliac, could not pass the wire any further. Then percutaneously stuck the Lt CFA and placed the stent in the distal Lt common iliac.
    My question is I know that I can bill 37207 for the stents in the RT common iliac and 37208 for the stent in the proxmial Lt common iliac but can I bill 37205 for the percutaneous stent in the distal common iliac since it was a different access point or not because it was the same vessel>
    Thanks
    Lisa
    That is quite a delima. I have a somewhat different thought process, see if it makes sense to you.

    There are two vessels being stented, the RT and LT common iliacs. The initial access was a cutdown of the RT common femoral artery, second access was the LT common femoral
    artery.

    to me a "cutdown" does not necessarily equate to "open". Case in point is access for a AAA repair 34800-34825, all involve opening the femorals, iliacs and/or brachial, but are not "open" procedures. Open repairs of AAA are 34830, or 35082-35103.

    Also, the definition of 37207-37208 from CDR " The physician makes an incision in the skin overlying the vessel to be catheterized. The vessel is dissected, and nicked with a small blade. A catheter with a stent-transporting tip is threaded into the vessel. The catheter travels to the point where the vessel needs additional support, and the compressed stent(s) is passed from the catheter into the vessel, where it expands to support the vessel walls...." at no point is the catheter advanced beyond the opened vessel.

    To me, this means a open stent procedure is when the catheter/stent is not advanced beyond the open vessel, in this case the RT common femoral. Since the catheter/stent was advanced beyond the open vessel, I would code it 37205/75960 for the initial vessel (RT common iliac) and 37206/75960 for the additional vessel (lt common iliac). There are certainly two catheters placed so I would add 36245 and 36140-59. Always code for the number of vessels treated/stented, not for the number of stents placed.

    HTH
    Danny L. Peoples
    CIRCC,CPC

  3. Default
    Presented very well and well done, Danny.

    I had been trying to understand the Rad coding and was a bit hard. You explained in a simple way.
    Could you please suggest (other than CPTmanual) some sites/ and a basic text to understand all these basic Rad. imaging Coding as for a beginner, in a very understandable way
    Your help would be greatly appreciated.
    Thank you.

  4. Smile
    Thanks you for your input. I have to disagree with you about the open stent. If you read the defination for a percutaneous stent is is worded the same way as the open, the only difference is the exposure of the vessel.So I tend to lean toward that fact that no matter where the catheter ends up if the exposure is a cut down then it would be considered a open stent. Does anyone else have any opinion on this?

  5. Default
    See whether it makes up some sense: Poking the skin and entering the vessel /and cuting the skin and make a nick ( cut open) over the vessel as an entry- merits to the term Endovascular procedure. Making an open approach thro the abdomen/or the site with a big incision to expose all the structures to the vision of the surgeon merits to Open vascular procedures.
    does this explain?

  6. #6
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    Quote Originally Posted by preserene View Post
    Presented very well and well done, Danny.

    I had been trying to understand the Rad coding and was a bit hard. You explained in a simple way.
    Could you please suggest (other than CPTmanual) some sites/ and a basic text to understand all these basic Rad. imaging Coding as for a beginner, in a very understandable way
    Your help would be greatly appreciated.
    Thank you.
    Zhealth publishing and Medical Asset Management are two companies (web sites) that offer procucts and services related to Interventional Radiology/Cardiology. IMO, they are both excellent resourses.

    HTH
    Danny L. Peoples
    CIRCC,CPC

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