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Thread: Accessing vein graft via LFA

  1. #1

    Default Accessing vein graft via LFA

    AAPC: Back to School
    I am hoping to get some help with the op-report below. I am confused on what I should be coding for catheterization of the vein graft.

    Access: left femoral artery

    The left common femoral artery was accessed at the fluoroscopically determined level of the femoral head after application of local anesthetic and incision of the skin. A 5 french micropuncture system with sheath was used.

    A 0.035 inch Glidewire was inserted into the aortoiliac system under fluoroscopic control. A Sos Omni catheter was inserted over the wire and used to select the right iliac system. Over the Glidewire, the SOS catheter was advanced from the common iliac into the external iliac and finally the proximal right common femoral artery.

    Right lower extremity angiography was then performed in stations from the right groin to the right ankle using hand injections through the catheter. Stenoses were identified in the native popliteal artery just proximal to the proximal anastomosis as well as just distal to the proximal anastomosis within the vein graft. The decision was taken to treat these lesions with angioplasty.

    The left femoral 5 French catheter was then exchanged over a Rosen wire for a 6 French 40 cm Balkan sheath which traversed the aortic bifurcation easily and was positioned in the proximal right superficial femoral artery. 5000 units of heparin were administered. Using a Glidewire supported by a Davis catheter, the proximal anastomosis of the vein graft was traversed and the Davis catheter advanced into the midportion of the vein graft. The Glidewire was then exchanged for a 0.014 inch road runner wire. Additional angiography was performed through the sheath to localize the stenosis. A 3 mm x 1.5 cm cutting balloon was advanced over the lesion and 3 serial overlapping inflations performed across the proximal anastomosis as well as in the native popliteal artery just proximal to the anastomosis. Angiography through the sheath showed moderate improvement. A 4 mm x 4 cm standard angioplasty balloon was then advanced to span the proximal anastomosis and inflated with excellent results.

    The wire was removed and the sheath withdrawn into the left common iliac artery where left iliofemoral arteriography was performed by hand-injection through the sheath. The left femoral puncture site was localized to the left common femoral artery over the femoral head. A Perclose procedure was performed at the left femoral puncture site followed by 10 minutes of manual compression. There was good hemostasis with no hematoma. A sterile dressing was applied. The patient tolerated the procedure well.

    Thank you for your help!

  2. #2


    Depending on your DOS I would code 37224 for the angioplasty. With this new code your cath placement is included.
    The area is still the same Fem/Pop Territory even though its a vein graft.
    Good question to ask Dr Z.
    Good luck

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