I would bill 36200, 75625, and 75716 since there are two catheter positions.Would I code the following as 36200 and 75630-26?
1. Abdominal aortogram with bilateral lower extremity runoff.
2. Bilateral lower extremity arteriogram.
3. Prior right femoral artery approach.
INDICATION: Recent coronary artery disease, status post left anterior
descending stenting. The patient underwent ABI revealing severe
occlusive disease bilaterally with ABI less than 0.6 bilaterally. The
patient has bilateral severe claudication.
PROTOCOL: The patient was brought to the vascular lab and both groins
are prepped and draped in the usual fashion. Written informed consent
was obtained. The right groin was accessed without difficulty and prior
advanced without difficulty. A 5 French sheath was inserted and 5
French OmniFlush catheter was used and placed at the level of L1.
Aortogram was done and subsequently pulled back to the level of L5 and
then subsequently the bolus chase imaging was performed using 80 mL of
contrast. No complications occurred.
1. The abdominal aorta and renal arteries appear to be normal.
2. Bilateral common iliac, external iliac, and femoral arteries are all
patent and appear with only mild luminal irregularities.
3. Bilateral superficial femoral arteries are showing only mild disease
and popliteal arteries are also intact. Left superficial femoral artery
visualization reveals presence of an arteriovenous fistula, which
appears to have a small amount of flow visualizing part of the femoral
4. Severe inferior popliteal disease is noted bilaterally.
5. Right circulation reveals total occlusion of the posterior tibial
artery and of the peroneal artery. There is visualization of the
anterior tibial artery, which visualizes all the way to the mid segment,
where severe occlusive disease is noted up to 99% severity. In the mid
part there is a short occlusion, which is followed by reconstitution of
the vessel, which appears to be favorable for crossing of the wire and
intervention with laser beyond which the reconstitution supplies the
arch and gets collaterals from the distal posterior tibial artery.
6. Left-sided circulation reveals more severe disease with occlusion of
all three channels and heavy collateral network is noted, which is
supplying faint tiny collateral to the distal anterior tibial artery.
The remaining vessels are occluded. Heavy collateral channel is noted
in the mid part of the lower leg and flow into the arch is present with
filling of the vessels in the foot.
PLAN: Based on these findings, since access was obtained on the right
side, right anterior tibial can be revascularized, however the left
anterior tibial is not suitable and will remain high risk due to very
small collateral coming off of the occlusion point and appears less
favorable. Therefore, the patient can be electively scheduled for right
anterior tibial percutaneous transluminal angioplasty with laser
athrectomy at a later date in 1-2 weeks.
Jim Pawloski, R.T.(R)(CV),CIRCC
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