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IR coding question

  1. Default IR coding question
    Exam Training Packages
    Can someone please help me with coding the following report? I am so lost with these new codes for 2011. Thanks in advance!

    RESULT: Procedures performed:
    1. Left lower extremity angiogram.
    2. Left superficial femoral artery/profundofemoral artery
    angioplasty.
    3. Left superficial femoral artery chemical and mechanical
    thrombolyzes and stent placement.
    4. Left popliteal/peroneal artery mechanical thrombolysis.

    History: 46-year-old female with recurrent left lower extremity
    arterial insufficiency ischemic symptoms. Patient has known
    peripheral arterial disease and is status post prior left lower
    extremity arteriogram and stent graft placement and angioplasty
    on

    Technique: Following a detailed discussion with the patient
    regarding the procedure, risks, benefits, and alternatives,
    informed consent was obtained and placed in the patient's
    medical record. This procedure is performed with conscious
    sedation using IV Versed and fentanyl. These were minister by
    radiology nursing staff personnel. Please refer to their notes
    for full details.

    The patient was placed supine on the angiography table. The
    right groin was prepped and draped in usual sterile fashion.
    The right common femoral artery was visualized under
    ultrasound an image was store for documentation of the access
    site. The skin and subcutaneous tissues were anesthetized
    lidocaine. A scalpel was used to make a small incision at the
    puncture site. Under ultrasound guidance a myocardial was
    placed into the right common femoral artery directed towards
    the abdominal aorta. A microwire was advanced through the
    needle was removed and exchanged for a 4 French micropuncture
    dilator. The wire and inner dilator were removed and exchanged
    for a Bentson wire to advance under fluoroscopic guidance into
    the abdominal aorta. A 4 French sheath was placed.

    A pigtail catheter was advanced into the abdominal aorta just
    above the level of the celiac trunk and abdominal aortogram was performed.

    The catheter was then pulled back to just above the aortoiliac
    bifurcation and oblique aortoiliac arteriograms of the pelvis
    were performed.

    The catheter was then draped over the aortoiliac bifurcation
    and an angled Glidewire was advanced into the left common
    iliac, external iliac, common femoral arteries. The catheter
    was removed and exchanged for an angled glide catheter. The
    wire was removed and exchanged for an exchange length Amplatz
    wire.

    An angled glide catheter was advanced to the distal left common
    femoral artery. A left lower extremity arteriogram was
    performed.

    A 6 French, 40 cm long Balkan sheath was exchanged for the 4
    French sheath and advanced under fluoroscopic guidance into the
    left common femoral artery.

    An angled glide catheter and Glidewire were used to select
    across the distal left common femoral artery/proximal
    profundofemoral artery junction. The wire was exchanged for the
    Amplatz wire. Angioplasty was performed with a 4 mm x40
    millimeters angioplasty balloon. A followup arteriogram was
    performed.

    The wire was then pulled back into the left common femoral
    artery. An angled lie catheter and angled Glidewire were used
    to select the left superficial femoral artery across the
    high-grade proximal stenosis. Angioplasty was then performed
    using a 5 mm x 40 mm angioplasty balloon across the left common
    femoral artery/superficial femoral artery stenosis. A followup
    arteriogram was performed.

    A total of 8000 units of heparin, 8 mg of TPA thrombolytic, and
    AngioJet mechanical thrombolyzes were required in conjunction
    with 5 mm x 120mm angioplasty to recanalize the newly
    thrombosed right superficial femoral artery. A followup
    arteriogram was performed.

    Mechanical thrombolyzes was performed in the distal left
    popliteal artery and into the tibioperoneal trunk. This was
    followed by 4 mm balloon angioplasty.

    The distal right lower extremity arteriogram with runoff was
    performed.

    Mechanical thrombolyzes was performed throughout the length of
    the left superficial femoral artery an additional time. A left
    common femoral artery/superficial femoral arteriogram was
    performed.

    Repeat angioplasty and mechanical thrombolyzes was required in
    the left superficial femoral artery and popliteal artery.

    A 5 mm x 30 mm Metronic stent was deployed across the most
    proximal portion of the left superficial femoral artery.


    A followup arteriogram was performed.

    A completion infrapopliteal left lower extremity arteriogram
    was performed.

    Once the ACT level reached below 175, the sheath was removed
    and hemostasis was obtained with manual compression. The
    patient tolerated the procedure well and left the department in
    baseline condition.

  2. #2
    Default
    Quote Originally Posted by cdc1cori View Post
    Can someone please help me with coding the following report? I am so lost with these new codes for 2011. Thanks in advance!

    RESULT: Procedures performed:
    1. Left lower extremity angiogram.
    2. Left superficial femoral artery/profundofemoral artery
    angioplasty.
    3. Left superficial femoral artery chemical and mechanical
    thrombolyzes and stent placement.
    4. Left popliteal/peroneal artery mechanical thrombolysis.

    History: 46-year-old female with recurrent left lower extremity
    arterial insufficiency ischemic symptoms. Patient has known
    peripheral arterial disease and is status post prior left lower
    extremity arteriogram and stent graft placement and angioplasty
    on

    Technique: Following a detailed discussion with the patient
    regarding the procedure, risks, benefits, and alternatives,
    informed consent was obtained and placed in the patient's
    medical record. This procedure is performed with conscious
    sedation using IV Versed and fentanyl. These were minister by
    radiology nursing staff personnel. Please refer to their notes
    for full details.

    The patient was placed supine on the angiography table. The
    right groin was prepped and draped in usual sterile fashion.
    The right common femoral artery was visualized under
    ultrasound an image was store for documentation of the access
    site. The skin and subcutaneous tissues were anesthetized
    lidocaine. A scalpel was used to make a small incision at the
    puncture site. Under ultrasound guidance a myocardial was
    placed into the right common femoral artery directed towards
    the abdominal aorta. A microwire was advanced through the
    needle was removed and exchanged for a 4 French micropuncture
    dilator. The wire and inner dilator were removed and exchanged
    for a Bentson wire to advance under fluoroscopic guidance into
    the abdominal aorta. A 4 French sheath was placed.

    A pigtail catheter was advanced into the abdominal aorta just
    above the level of the celiac trunk and abdominal aortogram was performed.

    The catheter was then pulled back to just above the aortoiliac
    bifurcation and oblique aortoiliac arteriograms of the pelvis
    were performed.

    The catheter was then draped over the aortoiliac bifurcation
    and an angled Glidewire was advanced into the left common
    iliac, external iliac, common femoral arteries. The catheter
    was removed and exchanged for an angled glide catheter. The
    wire was removed and exchanged for an exchange length Amplatz
    wire.

    An angled glide catheter was advanced to the distal left common
    femoral artery. A left lower extremity arteriogram was
    performed.

    A 6 French, 40 cm long Balkan sheath was exchanged for the 4
    French sheath and advanced under fluoroscopic guidance into the
    left common femoral artery.

    An angled glide catheter and Glidewire were used to select
    across the distal left common femoral artery/proximal
    profundofemoral artery junction. The wire was exchanged for the
    Amplatz wire. Angioplasty was performed with a 4 mm x40
    millimeters angioplasty balloon. A followup arteriogram was
    performed.

    The wire was then pulled back into the left common femoral
    artery. An angled lie catheter and angled Glidewire were used
    to select the left superficial femoral artery across the
    high-grade proximal stenosis. Angioplasty was then performed
    using a 5 mm x 40 mm angioplasty balloon across the left common
    femoral artery/superficial femoral artery stenosis. A followup
    arteriogram was performed.

    A total of 8000 units of heparin, 8 mg of TPA thrombolytic, and
    AngioJet mechanical thrombolyzes were required in conjunction
    with 5 mm x 120mm angioplasty to recanalize the newly
    thrombosed right superficial femoral artery. A followup
    arteriogram was performed.

    Mechanical thrombolyzes was performed in the distal left
    popliteal artery and into the tibioperoneal trunk. This was
    followed by 4 mm balloon angioplasty.

    The distal right lower extremity arteriogram with runoff was
    performed.

    Mechanical thrombolyzes was performed throughout the length of
    the left superficial femoral artery an additional time. A left
    common femoral artery/superficial femoral arteriogram was
    performed.

    Repeat angioplasty and mechanical thrombolyzes was required in
    the left superficial femoral artery and popliteal artery.

    A 5 mm x 30 mm Metronic stent was deployed across the most
    proximal portion of the left superficial femoral artery.


    A followup arteriogram was performed.

    A completion infrapopliteal left lower extremity arteriogram
    was performed.

    Once the ACT level reached below 175, the sheath was removed
    and hemostasis was obtained with manual compression. The
    patient tolerated the procedure well and left the department in
    baseline condition.
    You had to have fun with this one!
    75625 - Abd. Aortogram
    75710 - Lt leg angiogram
    37184 - Thrombolysis (mechanical)
    37226 - Stent in fem-pop. (includes PTA) (Zone 2)
    37232- PTA Tibioperoneal Trunk (Zone 3)
    Catheter position is bundled into stent procedure.

    HTH,
    Jim Pawloski, CIRCC

  3. Default
    Bless your heart!! I have just one more question, Do you just code for one of the mechanical thrombolysis? It was performed in the femoral AND popitieal/tibioperoneal arteries.

    Thanks for your help! This is starting to make sense...finally!!

  4. #4
    Default
    Quote Originally Posted by cdc1cori View Post
    Bless your heart!! I have just one more question, Do you just code for one of the mechanical thrombolysis? It was performed in the femoral AND popitieal/tibioperoneal arteries.

    Thanks for your help! This is starting to make sense...finally!!
    You can use 37185 for the tibioperoneal artery, popliteal is considered part of the SFA.

    Jim

  5. Default
    It makes a lot more sense.....Thanks again!

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