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Thread: Intervention in Lt leg... cath also placed in RT leg??

  1. #1
    Join Date
    Apr 2007
    Location
    Jackson, TN
    Posts
    62

    Default Intervention in Lt leg... cath also placed in RT leg??

    I don't know how I have not come across this before... or if I am just having a day that I am questioning myself.

    In short we did: RCF access, RCI stent, REI stent, then went contralaterally to the LCI to the the left leg angio... is the LCI cath placement bundled? I know this is a seperate vascular family so my instinct is to bill it but for some reason I am questioning myself.

    Please read the below note and let me know your input.

    Procedure Detail reads:

    RCF access was obtained using modified seldinger technique and 6f introducer sheath was used to cannulate the right common femoral artery. The pigtail catheter was advanced to the distal aorta and distal aortography was performed with the 6f pigtail catheter. Distal aorta has mild disease, giving origin to the right common iliac artery and left common iliac artery.

    Left common iliac artery has no disease. Right common iliac artery has 75-80% stenosis. Right external iliac artery has 70% proximal stenosis.

    Ath this time I decided to intervene on the right common iliac artery lesion and right external iliac artery lesion. Heparin was given for anticoagualtion. J-wire was advanced across the lesion and a 7 x 56 mm Express LD stent was advacned and deployed at the lesion site up to 14 atmospheres for 45 seconds. The lesion was reduced from 70 to 0%. A 7 x 39mm Express LD stent was advanced and deployed at the lesion of the right external iliac artery. The lesion was reduced to 0%. TIMI-3 flow was established with no complications.

    The tip of the pigtail catheter was advanced across the aortoiliac bifurcation. The wire was advanced across the left common iliac artery. Glide catheter was positioned in the left common iliac artery. Selective left common iliac artery angiogram with distal run off was performed. Left common femoral artery has 50% stenosis proximally, giving origin to the left profunda and left SFA. Left SFA has more than 80% stenosis, eccentric lesion - multiple lesions were seen. Left popliteal artery has more than 85% stenosis, very eccentric. Left anterior tibial artey is totally occuluded. Left tibioperoneal trunk has 90% mid stenosis, single vessel run off.

    RCF artery angiogram with distal run off was performed. RCF artery has mild disease, giving origin to right profunda and right superficial femoral artery. There appears to be around 70% stenosis at the superficial femoral artery/profunda bifurcation. The rught superficial femoral artery has more than 95% proximal stenosis, diffuse disease otherwise. Right popliteal artery has 50-60% proximal stenosis. Right tibioperoneal trunk has more than 95% stenosis. Only single vessel run off was visualized.

    end.

    I coded this as:

    75625 abd angio
    37221 RCI stent
    37223 REI stent
    36245 LCI cath placement
    75716 Bil leg angio

    Please let me know what you think about the cath placement in the LCI? Would you bill?
    C. Weaver, CPC, CCC

  2. #2
    Join Date
    Apr 2007
    Location
    Birmingham, Alabama
    Posts
    887

    Default

    Quote Originally Posted by cweavercpc View Post
    I don't know how I have not come across this before... or if I am just having a day that I am questioning myself.

    In short we did: RCF access, RCI stent, REI stent, then went contralaterally to the LCI to the the left leg angio... is the LCI cath placement bundled? I know this is a seperate vascular family so my instinct is to bill it but for some reason I am questioning myself.

    Please read the below note and let me know your input.

    Procedure Detail reads:

    RCF access was obtained using modified seldinger technique and 6f introducer sheath was used to cannulate the right common femoral artery. The pigtail catheter was advanced to the distal aorta and distal aortography was performed with the 6f pigtail catheter. Distal aorta has mild disease, giving origin to the right common iliac artery and left common iliac artery.

    Left common iliac artery has no disease. Right common iliac artery has 75-80% stenosis. Right external iliac artery has 70% proximal stenosis.

    Ath this time I decided to intervene on the right common iliac artery lesion and right external iliac artery lesion. Heparin was given for anticoagualtion. J-wire was advanced across the lesion and a 7 x 56 mm Express LD stent was advacned and deployed at the lesion site up to 14 atmospheres for 45 seconds. The lesion was reduced from 70 to 0%. A 7 x 39mm Express LD stent was advanced and deployed at the lesion of the right external iliac artery. The lesion was reduced to 0%. TIMI-3 flow was established with no complications.

    The tip of the pigtail catheter was advanced across the aortoiliac bifurcation. The wire was advanced across the left common iliac artery. Glide catheter was positioned in the left common iliac artery. Selective left common iliac artery angiogram with distal run off was performed. Left common femoral artery has 50% stenosis proximally, giving origin to the left profunda and left SFA. Left SFA has more than 80% stenosis, eccentric lesion - multiple lesions were seen. Left popliteal artery has more than 85% stenosis, very eccentric. Left anterior tibial artey is totally occuluded. Left tibioperoneal trunk has 90% mid stenosis, single vessel run off.

    RCF artery angiogram with distal run off was performed. RCF artery has mild disease, giving origin to right profunda and right superficial femoral artery. There appears to be around 70% stenosis at the superficial femoral artery/profunda bifurcation. The rught superficial femoral artery has more than 95% proximal stenosis, diffuse disease otherwise. Right popliteal artery has 50-60% proximal stenosis. Right tibioperoneal trunk has more than 95% stenosis. Only single vessel run off was visualized.

    end.

    I coded this as:

    75625 abd angio
    37221 RCI stent
    37223 REI stent
    36245 LCI cath placement
    75716 Bil leg angio

    Please let me know what you think about the cath placement in the LCI? Would you bill?
    yes, code 36245 with a 59 modifier. I agree with the other codes as well except the
    75625. I don't see enough documentation (interpretation) for an abdominal angiography, nor do I see medical necessity.

    HTH
    Danny L. Peoples
    CIRCC,CPC

  3. #3
    Join Date
    Apr 2007
    Location
    Jackson, TN
    Posts
    62

    Default

    Thanks Danny! I agree the abd angio findings is lacking and the cath placement for it should have been better documented.

    I appreciate your help!
    C. Weaver, CPC, CCC

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