Results 1 to 3 of 3

Thread: NEED HELP w/Peripheral study,stenting,etc

  1. #1
    Join Date
    Apr 2007
    Location
    Jonesboro
    Posts
    52

    Default NEED HELP w/Peripheral study,stenting,etc

    Promo: Code Books
    PROCEDURES: Aortic Root Angiography, Selective Right
    Brachiocephalic Angiography, Selective Common Carotid
    Angiography, Selective Left Vertebral Angiography. Selective
    Abdominal Aortogram at the level of the renal arteries, Abdominal
    Aortogram at the level of the Iliac Bifurcation, Selective Right
    Common Iliac angiogram.

    Angioplasty of the right common femoral, and Stenting of the
    ostium of the right common iliac.

    INDICATIONS: Claudication with ABI of .6 on the right.

    History of brachiocephalic stenting in 2005, recent Doppler
    revealing subclavian steal on the right and CTA revealing
    significant stenosis of the right branchiocephalic stents.

    No right femoral pulse could be felt. We did feel the ridge,
    which felt to be the artery and were able to cannulate the right
    femoral even though no pulse could be felt. We had to use a
    glide wire to advance to the distal abdominal aorta. This was
    achieved. Angiograms subsequently of the abdominal aorta
    revealed the abdominal aorta to be patent at the level of the
    renal arteries. There was a 30% or so left renal artery
    stenosis. The right renal appeared okay but it was somewhat
    obscured by the mesenteric artery. Below the renal arteries the
    abdominal aorta had about a 30-40% area of narrowing. It was
    focal and had about a 10mm gradient across this area. The distal
    aorta was patent and the left common iliac widely patent. The
    right common iliac had a severe stenosis. There appeared to be a
    70% stenosis at the origin of the right common iliac and there
    was a 40mm gradient across this lesion. The external iliac had
    no flow and the common femoral filled via internal iliac
    collaterals to the profunda and SFA. The external iliac and the
    common femoral were totally occluded with no flow on the right.


    ACCESS: Access through the left femoral was also achieved.

    A 6 French 55 Rabbe sheath placed. Using crossover technique the
    sheath was placed in the proximal iliac on the right. Angiograms
    were obtained and the lesion is again identified. The total
    occlusion of the external iliac and common femoral was crossed.
    The distal common femoral was difficult to cross but this was
    finally achieved with the wire placed into the SFA. A 4.0 X
    150mm balloon was then utilized. Balloon was inflated up to 10
    bars and finally to 14 bars, which is about a 4.4 size. The total
    external iliac and common femoral stenosis was opened with
    excellent results with 0% residual and excellent flow and return
    of the pedal pulses.

    The ostium of the right internal iliac did dissect with placement
    with the crossover technique. This was at the side of the lesion.
    This was subsequently stented with a 7 x 18 balloon expandible
    bare metal stent. There was 0% residual, excellent flow and
    resolution of the dissection with the placement of the ostial
    iliac stent on the right. Post stent placement excellent results
    were obtained with 0% residual and excellent flow. No compromise
    of the left iliac detected.

    AORTIC ROOT ANGIOGRAPHY: Reveals total occlusion of the
    branchiocephalic on the right with delayed collateral filling
    from the subclavian, the subclavian via the basilar artery. The
    left common carotid and the left subclavian appeared normal.

    SELECTIVE RIGHT BRACHIOCEPHALIC ANGIOGRAM: Reveals the proximal
    ostial branchiocephalic stent to be totally occluded. There is no
    filling of the brachiocephalic, carotid or subclavian noted by
    antegrade flow.

    LEFT COMMON CAROTID ANGIOGRAM: This reveals the common carotid to
    be widely patent with no stenosis. There is minimal stenosis or
    irregularity at the origin of the internal carotid. There is
    excellent filling of the anterior middle cerebrals from the left
    carotid.

    LEFT VERTEBRAL ANGIOGRAPHY: This reveals the left vertebral to be
    very large, widely patent and via the basilar artery. Retrograde
    flow down the right vertebral filling the right subclavian with
    retrograde flow back to the brachiocephalic and also filling the
    right carotid. The basilar artery also supplies both posterior
    cerebral arteries. There is again collateral flow from the
    vertebral on the left to the right subclavian via the right
    vertebral that supplies the right subclavian, also the right
    carotid and the right carotid supplies the anterior middle
    cerbral normally on the right by this collateral flow.

    Ok, this one is a new one for me. i don't think i've ever had all of these in one procedure. Just wanting to make sure I haven't missed anything.. so far i have:
    37224
    37221
    71710-26
    75650-26
    36217-59
    75625-26

    Any help is very much appreciated!!

  2. #2
    Join Date
    Apr 2007
    Location
    Des Moines, IA
    Posts
    36

    Default

    Is some of the procedure missing, because I see where the findings for the upper portion are documented, but not the "pathway" to get there. For the upper portion, the closest clue I get is the wording of "selective right brachiocephalic angiogram" which is a 1st order. As far as what he/she viewed on the left, where was the cath? Was all of that seen from an additional shot in the aorta?

    Based on what I read, I got the following:

    From the left femoral:
    37224
    37221

    From the right femoral:
    36200-59
    75625-26

    Upper (possibly):
    36215-59
    75710-26
    75685-26
    75676-26
    75650-26

    I think I got it all- I was rushed at the end. Hope that helps!
    Michelle

  3. #3
    Join Date
    Apr 2007
    Location
    Ann Arbor
    Posts
    1,027

    Default

    Quote Originally Posted by sslater View Post
    PROCEDURES: Aortic Root Angiography, Selective Right
    Brachiocephalic Angiography, Selective Common Carotid
    Angiography, Selective Left Vertebral Angiography. Selective
    Abdominal Aortogram at the level of the renal arteries, Abdominal
    Aortogram at the level of the Iliac Bifurcation, Selective Right
    Common Iliac angiogram.

    Angioplasty of the right common femoral, and Stenting of the
    ostium of the right common iliac.

    INDICATIONS: Claudication with ABI of .6 on the right.

    History of brachiocephalic stenting in 2005, recent Doppler
    revealing subclavian steal on the right and CTA revealing
    significant stenosis of the right branchiocephalic stents.

    No right femoral pulse could be felt. We did feel the ridge,
    which felt to be the artery and were able to cannulate the right
    femoral even though no pulse could be felt. We had to use a
    glide wire to advance to the distal abdominal aorta. This was
    achieved. Angiograms subsequently of the abdominal aorta
    revealed the abdominal aorta to be patent at the level of the
    renal arteries. There was a 30% or so left renal artery
    stenosis. The right renal appeared okay but it was somewhat
    obscured by the mesenteric artery. Below the renal arteries the
    abdominal aorta had about a 30-40% area of narrowing. It was
    focal and had about a 10mm gradient across this area. The distal
    aorta was patent and the left common iliac widely patent. The
    right common iliac had a severe stenosis. There appeared to be a
    70% stenosis at the origin of the right common iliac and there
    was a 40mm gradient across this lesion. The external iliac had
    no flow and the common femoral filled via internal iliac
    collaterals to the profunda and SFA. The external iliac and the
    common femoral were totally occluded with no flow on the right.


    ACCESS: Access through the left femoral was also achieved.

    A 6 French 55 Rabbe sheath placed. Using crossover technique the
    sheath was placed in the proximal iliac on the right. Angiograms
    were obtained and the lesion is again identified. The total
    occlusion of the external iliac and common femoral was crossed.
    The distal common femoral was difficult to cross but this was
    finally achieved with the wire placed into the SFA. A 4.0 X
    150mm balloon was then utilized. Balloon was inflated up to 10
    bars and finally to 14 bars, which is about a 4.4 size. The total
    external iliac and common femoral stenosis was opened with
    excellent results with 0% residual and excellent flow and return
    of the pedal pulses.

    The ostium of the right internal iliac did dissect with placement
    with the crossover technique. This was at the side of the lesion.
    This was subsequently stented with a 7 x 18 balloon expandible
    bare metal stent. There was 0% residual, excellent flow and
    resolution of the dissection with the placement of the ostial
    iliac stent on the right. Post stent placement excellent results
    were obtained with 0% residual and excellent flow. No compromise
    of the left iliac detected.

    AORTIC ROOT ANGIOGRAPHY: Reveals total occlusion of the
    branchiocephalic on the right with delayed collateral filling
    from the subclavian, the subclavian via the basilar artery. The
    left common carotid and the left subclavian appeared normal.

    SELECTIVE RIGHT BRACHIOCEPHALIC ANGIOGRAM: Reveals the proximal
    ostial branchiocephalic stent to be totally occluded. There is no
    filling of the brachiocephalic, carotid or subclavian noted by
    antegrade flow.

    LEFT COMMON CAROTID ANGIOGRAM: This reveals the common carotid to
    be widely patent with no stenosis. There is minimal stenosis or
    irregularity at the origin of the internal carotid. There is
    excellent filling of the anterior middle cerebrals from the left
    carotid.

    LEFT VERTEBRAL ANGIOGRAPHY: This reveals the left vertebral to be
    very large, widely patent and via the basilar artery. Retrograde
    flow down the right vertebral filling the right subclavian with
    retrograde flow back to the brachiocephalic and also filling the
    right carotid. The basilar artery also supplies both posterior
    cerebral arteries. There is again collateral flow from the
    vertebral on the left to the right subclavian via the right
    vertebral that supplies the right subclavian, also the right
    carotid and the right carotid supplies the anterior middle
    cerbral normally on the right by this collateral flow.

    Ok, this one is a new one for me. i don't think i've ever had all of these in one procedure. Just wanting to make sure I haven't missed anything.. so far i have:
    37224
    37221
    71710-26
    75650-26
    36217-59
    75625-26

    Any help is very much appreciated!!
    My question on this is there is no dictation of any catheter placement in the thoracic aorta or in the innominate, lt carotid, and left vertebral systems. Did you just leave that part out and give us just the interpretation of the proximal thoracic aorta?

    Thanks,
    Jim Pawloski, CIRCC

Similar Threads

  1. carotid stenting w.innominate stenting
    By mabar1571 in forum Interventional Radiology
    Replies: 3
    Last Post: 05-11-2012, 12:28 PM
  2. Peripheral Angiography/Angioplasty/Stenting
    By em2177 in forum Cardiology
    Replies: 1
    Last Post: 04-27-2012, 09:30 PM
  3. Peripheral Bone Density Study
    By dballard2004 in forum Interventional Radiology
    Replies: 2
    Last Post: 04-06-2012, 03:16 PM
  4. Peripheral study/stenting...
    By sslater in forum Cardiology
    Replies: 6
    Last Post: 07-29-2011, 02:09 PM
  5. How to code peripheral pressure wire study?
    By JSpad2000 in forum Cardiology
    Replies: 3
    Last Post: 09-30-2010, 10:23 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.