Since there wasn't an diagnostic angio performed, that is all you can bill.Can I bill anything else other than 37227?
1. Antegrade arterial stick to the left common femoral artery.
2. Laser atherectomy followed by balloon percutaneous transluminal
angioplasty to the distal superficial femoral artery/popliteal artery
chronic total occlusion.
3. Percutaneous transluminal angioplasty to mid superficial femoral
4. Placement of stent to the common femoral artery at the level of the
groin with IDEV stent.
INDICATION: The patient is presenting with gangrene to the left fifth
toe and also severe ischemic changes of the left foot. Finding of
severe occlusive disease with total occlusion of the superficial femoral
artery in the distal third and going into the popliteal and high grade
stenosis in the mid superficial femoral artery and high grade stenosis
of the common femoral artery with significantly reduced inflow and
revascularization is recommended.
PROTOCOL: After the patient was identified, the patient was brought to
the endovascular lab. This is a very lengthy and long procedure and
required multiple levels of procedural sedation. At this point first an
antegrade 7 French stick was performed to the left common femoral artery
and then subsequently guidewire was advanced into the superficial
femoral artery. At this point a Storq catheter was used to exchange the
wire. After the Storq wire was advanced and crossed the lesion distally
in the lower third and then at this point was exchanged with an 0.014
wire upon which a 2.0 laser fiber was advanced and multiple passes were
made of the chronic occlusion. Improvement was noted and subsequently
followed by a 4 x 80 Admiral balloon with excellent results with full
restoration of flow noted in this segment.
Attention was directed to the mid superficial femoral artery. The same
4 x 80 Admiral balloon was then used to dilate in the mid segment with
marked improvement and therefore it was felt not to be necessary to
stent it. Subsequently, the same balloon was pulled back into the
common femoral artery in the area of a very complex and calcified high
grade stenosis of the superficial femoral artery was treated with a
balloon inflation first. Subsequently, IDEV 5 x 60 stent was then
delivered at this area with full coverage with excellent placement.
Following this a 6 x 40 balloon was used, which post dilate excellent
end results were noted with marked improvement and the entire flow was
pictured and excellent three vessel runoff was noted to the foot.
Jim Pawloski, CIRCC
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