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Attempted Percutaneous/luminal angioplasty

  1. #1
    Default Attempted Percutaneous/luminal angioplasty
    Medical Coding Books
    I am having trouble with a couple of reports. I hope that someone will be albe to help me. Here is the first one.

    Attempted percutaneous;luminal angioplasty of the left superficial femoral artery.


    Procedure in Detail: Ther right groin was prepped and draped in the usual manner. The skin infiltrated with Xylocaine 1%. Using the Cournand needle, the right femoral artery was entered and a J wire . A 7-French sheath was positioned in place and 5000 units of heparin given at this point. We used left internal mammary artery diagnostic catheter to go over to the left common iliac and used a glidewire at which time that allowed us to exchange the system for a J curve 7-French peripheral sheath that was advanced all the way to the left external iliac. We then used 2 glidewires, one that going to the profunda artery and the other one that was moved to the superficial femoral artery. Using a Quick Cross catheter, we tried to advance our way through the total occlusion of the superficial femoral artery gradually' however due to severe calcification of the vessel, the wire and the Quick Cross entered a false lumen. After multiple attempts to try to advance the wire into the real lumen and passed a calcified artery, we decided to stop the procedure after trying several differernt wires due to inability to cross the artery. Subsequently after almost 2 hours of work, we decided to stop the porcedure and transfer the patient back to his room with a 7-French short sheath switched to the right femoral artery. The previous wquipment was previously exhcanged over 0.35 wire.

    Impression: Unsuccessful percutaneous transluminal angioplasty of the left superficial femoral artery due to inability to advace the wire and a Quick Cross catheter passed the proximal portion of the left superficial femoral artery.

    I would appreciate any help.
    Thanks,
    Leslie

    .
    Last edited by willnat2; 07-28-2011 at 04:12 PM.

  2. Default
    Quote Originally Posted by willnat2 View Post
    I am having trouble with a couple of reports. I hope that someone will be albe to help me. Here is the first one.

    Attempted percutaneous;luminal angioplasty of the left superficial femoral artery.


    Procedure in Detail: Ther right groin was prepped and draped in the usual manner. The skin infiltrated with Xylocaine 1%. Using the Cournand needle, the right femoral artery was entered and a J wire . A 7-French sheath was positioned in place and 5000 units of heparin given at this point. We used left internal mammary artery diagnostic catheter to go over to the left common iliac and used a glidewire at which time that allowed us to exchange the system for a J curve 7-French peripheral sheath that was advanced all the way to the left external iliac. We then used 2 glidewires, one that going to the profunda artery and the other one that was moved to the superficial femoral artery. Using a Quick Cross catheter, we tried to advance our way through the total occlusion of the superficial femoral artery gradually' however due to severe calcification of the vessel, the wire and the Quick Cross entered a false lumen. After multiple attempts to try to advance the wire into the real lumen and passed a calcified artery, we decided to stop the procedure after trying several differernt wires due to inability to cross the artery. Subsequently after almost 2 hours of work, we decided to stop the porcedure and transfer the patient back to his room with a 7-French short sheath switched to the right femoral artery. The previous wquipment was previously exhcanged over 0.35 wire.

    Impression: Unsuccessful percutaneous transluminal angioplasty of the left superficial femoral artery due to inability to advace the wire and a Quick Cross catheter passed the proximal portion of the left superficial femoral artery.

    I would appreciate any help.
    Thanks,
    Leslie

    .
    on these cases what you usually would want to do is code what was actually done or code the angioplasty with a modifier 52. 52 means procedure was stopped and patient is stable.
    Theresa CCS-P CPMA CCC ICDCT-CM

  3. #3
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by theresa.dix@ethc.com View Post
    on these cases what you usually would want to do is code what was actually done or code the angioplasty with a modifier 52. 52 means procedure was stopped and patient is stable.
    I would code what was actually done, 36247. If they had placed a balloon then I would consider coding the angioplasty with a modifier 52.

    HTH
    Danny L. Peoples
    CIRCC,CPC

  4. #4
    Default
    Thank you Theresa and Danny for your help. On the doctors hospital card he put down that he took extra time. And in the report it says, "Subsequently after almost 2 hours of work, we decided to stop the porcedure and transfer the patient back to his room." So would I add a 22 modifier on the 36247? Where do I find more out about the the second and third order extremity artery branches?
    If I posted it the way Theresa said with the 52 modifier, would it be 37224 52? I would appreciate any feedback. I am just trying to figure this all out.

    Thanks,
    Leslie

  5. Default
    Quote Originally Posted by willnat2 View Post
    Thank you Theresa and Danny for your help. On the doctors hospital card he put down that he took extra time. And in the report it says, "Subsequently after almost 2 hours of work, we decided to stop the porcedure and transfer the patient back to his room." So would I add a 22 modifier on the 36247? Where do I find more out about the the second and third order extremity artery branches?
    If I posted it the way Theresa said with the 52 modifier, would it be 37224 52? I would appreciate any feedback. I am just trying to figure this all out.

    Thanks,
    Leslie

    Leslie,
    yes if you posted it the way I said sometimes on these cases you would use the 37224-52. But I do agree with Danny that I would use what was actually acomplished. 36247.Sometimes the decision is hard to make because there are no set rules on how to code certain cases. You have to just read and make a decision based on what you feel is the best way to code. Just keep on asking questions and reading anything you can and it will all come to you.
    Theresa CCS-P CPMA CCC ICDCT-CM

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