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Interventional Coding

  1. #1
    Question Interventional Coding
    Medical Coding Books
    Still need help with these. Can't quite understand the difference between different approach.

    I have 37226 for the stent but what about the approach?

    PROCEDURES PERFORMED:
    1. Antegrade left femoral artery approach.
    2. Stenting followed by percutaneous transluminal angioplasty of the mid
    left superficial femoral artery.

    CLINICAL SUMMARY: The patient is a 46-year-old female with profound
    claudication affecting her left leg. She underwent peripheral
    arteriogram on April 1, 2011 and was found to have a left superficial
    femoral artery middle/distal third junction focal stenosis of 80%
    severity. It was felt that because of the very acute angulation at the
    bifuraction of the aorta, the only viable approach would be an antegrade
    femoral artery access. Therefore, she was scheduled electively for stent
    procedure today.

    PROTOCOL: The patient was brought to the endovascular lab and both
    groins were prepped and draped in the usual sterile fashion. Under
    fluoro guidance, the left common femoral artery was marked and access
    was obtained antegrade ________ with passage of wire into the
    superficial femoral artery and then subsequently a dilator was advanced
    to confirm positioning and then subsequently a 6 French 6 x 23 sheath
    was advanced and positioned in the left superficial femoral artery
    selectively.

    At this point, imaging confirmed the lesion and it was felt that a focal
    stent approach was the most appropriate one and a Life stent 6 x 60 was
    placed at the lesion site under fluoro guidance and then deployed
    successfully, covering the two lesions that were close to each other.
    Following which significant narrowing existed and therefore a 7 x 40
    balloon was used to post dilate this lesion to full expansion.
    Excellent results were noted at this point and patient was given Plavix,
    even through she has received heparin. The sheath was pulled and then
    manual compression was used for hemostasis. There were good pulses
    present at the end of the procedure. No complications occurred.

    IMPRESSION:

    FINAL SUCCESSFUL STENTING FOLLOWING PERCUTANEOUS TRANSLUMINAL
    ANGIOPLASTY. BALLOON INFLATION OF THE MID LEFT SUPERFICIAL FEMORAL
    ARTERY WITH 6 X 60 LIFE STENT, POST DILATED WITH 7 X 40 RIVAL BALLOON
    WITH STENOSIS REDUCTION FROM 80% TO 0%.

    Thanks for your help!

  2. #2
    Default
    Quote Originally Posted by amym View Post
    Still need help with these. Can't quite understand the difference between different approach.

    I have 37226 for the stent but what about the approach?

    PROCEDURES PERFORMED:
    1. Antegrade left femoral artery approach.
    2. Stenting followed by percutaneous transluminal angioplasty of the mid
    left superficial femoral artery.

    CLINICAL SUMMARY: The patient is a 46-year-old female with profound
    claudication affecting her left leg. She underwent peripheral
    arteriogram on April 1, 2011 and was found to have a left superficial
    femoral artery middle/distal third junction focal stenosis of 80%
    severity. It was felt that because of the very acute angulation at the
    bifuraction of the aorta, the only viable approach would be an antegrade
    femoral artery access. Therefore, she was scheduled electively for stent
    procedure today.

    PROTOCOL: The patient was brought to the endovascular lab and both
    groins were prepped and draped in the usual sterile fashion. Under
    fluoro guidance, the left common femoral artery was marked and access
    was obtained antegrade ________ with passage of wire into the
    superficial femoral artery and then subsequently a dilator was advanced
    to confirm positioning and then subsequently a 6 French 6 x 23 sheath
    was advanced and positioned in the left superficial femoral artery
    selectively.

    At this point, imaging confirmed the lesion and it was felt that a focal
    stent approach was the most appropriate one and a Life stent 6 x 60 was
    placed at the lesion site under fluoro guidance and then deployed
    successfully, covering the two lesions that were close to each other.
    Following which significant narrowing existed and therefore a 7 x 40
    balloon was used to post dilate this lesion to full expansion.
    Excellent results were noted at this point and patient was given Plavix,
    even through she has received heparin. The sheath was pulled and then
    manual compression was used for hemostasis. There were good pulses
    present at the end of the procedure. No complications occurred.

    IMPRESSION:

    FINAL SUCCESSFUL STENTING FOLLOWING PERCUTANEOUS TRANSLUMINAL
    ANGIOPLASTY. BALLOON INFLATION OF THE MID LEFT SUPERFICIAL FEMORAL
    ARTERY WITH 6 X 60 LIFE STENT, POST DILATED WITH 7 X 40 RIVAL BALLOON
    WITH STENOSIS REDUCTION FROM 80% TO 0%.

    Thanks for your help!
    That's all you can bill. There is a previous arteriogram, so you can't bill for diagnostic imaging. Since all work was performed from a single access site, all catheter placements and imaging is bundled into the stent placement.
    HTH,
    Jim Pawloski, R.T.(R)(CV), CIRCC

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