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PTA + Stenting

  1. #1
    Question PTA + Stenting
    Medical Coding Books
    PROCEDURE PERFORMED:
    1. Peripheral arteriogram with bilateral lower extremity runoff.
    2. Percutaneous transluminal angioplasty of the proximal superficial
    femoral artery.
    3. Percutaneous transluminal angioplasty and stenting of the left
    tibiofemoral trunk.

    INDICATION: Severe claudication effect in the left leg.

    SUMMARY: After informed consent, the patient was brought to the
    peripheral vascular lab and the right groin access was obtained without
    difficulty and OmniFlush catheter was advanced at the level of L1.
    Imaging was obtained for abdominal aorta with digital subtraction. The
    catheter was pulled above the bifurcation and bilateral lower extremity
    runoff was performed using bolus chase method. No complications
    occurred. Subsequently percutaneous transluminal angioplasty of the
    left leg was performed.

    FINDINGS:
    1. The visualized portions of the aorta are normal.
    2. Bilateral common iliac, external iliac, and common femoral arteries
    show only mild atherosclerosis.
    3. There is severe disease below the common femoral artery.
    4. Right circulation reveals flash occlusion of the right superficial
    femoral artery, which reconstitutes at the level of the popliteal
    artery. There is high grade stenosis of the posterior tibial artery of
    90% and anterior tibial is totally occluded. There is two vessel runoff
    to the distal extremity with posterior tibial and peroneal artery and
    reconstitution of a portion of the anterior tibial artery.
    5. The left superficial femoral artery shows heavy disease diffusely in
    the proximal third and at the junction of proximal third to the middle
    third there is a 95% stenosis, which is followed by once again diffuse
    disease leading up to 60-70% stenosis in the middle third and then
    subsequently fairly normal caliber at the level of the popliteal artery.
    The left popliteal artery then leads to tibioperoneal trunk. The
    anterior tibial artery is occluded immediately after the takeoff and at
    the take off of the anterior tibial artery there is a 90% stenosis of
    the tibioperoneal trunk leading up to two vessel runoff with posterior
    tibial and peroneal artery supplying the foot with some reconstitution
    of the anterior tibial artery as well.
    6. Severe vascular disease as described above effecting the right
    superficial femoral artery occlusion throughout its length with
    reconstitution of the popliteal artery and two vessel runoff using
    posterior tibial and peroneal arteries in the right leg.
    7. Left superficial femoral artery with 95% stenosis in the proximal
    third and 90% stenosis of the tibioperoneal trunk leading to two vessel
    runoff on the left side.
    8. Recommend PCI and CPI protocol. Recommend percutaneous transluminal
    angioplasty. Percutaneous transluminal angioplasty with contralateral
    approach was used and a 7-French sheath was advanced and crossed over
    the bifurcation into the left common femoral artery. Imaging was
    obtained and subsequently an 0.014 guidewire was advanced and lesion in
    the superficial femoral artery was first crossed. The superficial
    femoral artery was dilated with a 4 mm balloon. Multiple inflations
    were done with marked improvement, with excellent improvement in flow.
    The middle lesions were not dilated due to concern for dissection. Wire
    was then advanced and attention was focused to the tibioperoneal
    disease.
    9. The tibioperoneal trunk was crossed with an 0.014 wire and
    significant attempt was made to cross into the anterior tibial artery.
    This was not successful. The wire was placed in the peroneal artery and
    then using the 4 mm balloon this was dilated and subsequently a 4 x 60
    I-
    DEV stent was then delivered to the tibioperoneal trunk with excellent
    results. Marked improvement was noted in the distal extremity as well
    and at this point the entire assembly was removed. No complications
    occurred.

    FINAL RESULTS:
    1. Successful percutaneous transluminal angioplasty of the left
    superficial femoral artery with 4 mm balloon with stenosis reduction
    from 95% to less than 40%.
    2. Successful percutaneous transluminal angioplasty and stenting of the
    tibioperoneal trunk using I-DEV 4 x 60 stent with stenosis reduction
    from 90% to less than 20%.

    Is it appropriate to code this as: 37224, 37230, 75716-26-59, 75625-26?

  2. #2
    Default
    Quote Originally Posted by amym View Post
    PROCEDURE PERFORMED:
    1. Peripheral arteriogram with bilateral lower extremity runoff.
    2. Percutaneous transluminal angioplasty of the proximal superficial
    femoral artery.
    3. Percutaneous transluminal angioplasty and stenting of the left
    tibiofemoral trunk.

    INDICATION: Severe claudication effect in the left leg.

    SUMMARY: After informed consent, the patient was brought to the
    peripheral vascular lab and the right groin access was obtained without
    difficulty and OmniFlush catheter was advanced at the level of L1.
    Imaging was obtained for abdominal aorta with digital subtraction. The
    catheter was pulled above the bifurcation and bilateral lower extremity
    runoff was performed using bolus chase method. No complications
    occurred. Subsequently percutaneous transluminal angioplasty of the
    left leg was performed.

    FINDINGS:
    1. The visualized portions of the aorta are normal.
    2. Bilateral common iliac, external iliac, and common femoral arteries
    show only mild atherosclerosis.
    3. There is severe disease below the common femoral artery.
    4. Right circulation reveals flash occlusion of the right superficial
    femoral artery, which reconstitutes at the level of the popliteal
    artery. There is high grade stenosis of the posterior tibial artery of
    90% and anterior tibial is totally occluded. There is two vessel runoff
    to the distal extremity with posterior tibial and peroneal artery and
    reconstitution of a portion of the anterior tibial artery.
    5. The left superficial femoral artery shows heavy disease diffusely in
    the proximal third and at the junction of proximal third to the middle
    third there is a 95% stenosis, which is followed by once again diffuse
    disease leading up to 60-70% stenosis in the middle third and then
    subsequently fairly normal caliber at the level of the popliteal artery.
    The left popliteal artery then leads to tibioperoneal trunk. The
    anterior tibial artery is occluded immediately after the takeoff and at
    the take off of the anterior tibial artery there is a 90% stenosis of
    the tibioperoneal trunk leading up to two vessel runoff with posterior
    tibial and peroneal artery supplying the foot with some reconstitution
    of the anterior tibial artery as well.
    6. Severe vascular disease as described above effecting the right
    superficial femoral artery occlusion throughout its length with
    reconstitution of the popliteal artery and two vessel runoff using
    posterior tibial and peroneal arteries in the right leg.
    7. Left superficial femoral artery with 95% stenosis in the proximal
    third and 90% stenosis of the tibioperoneal trunk leading to two vessel
    runoff on the left side.
    8. Recommend PCI and CPI protocol. Recommend percutaneous transluminal
    angioplasty. Percutaneous transluminal angioplasty with contralateral
    approach was used and a 7-French sheath was advanced and crossed over
    the bifurcation into the left common femoral artery. Imaging was
    obtained and subsequently an 0.014 guidewire was advanced and lesion in
    the superficial femoral artery was first crossed. The superficial
    femoral artery was dilated with a 4 mm balloon. Multiple inflations
    were done with marked improvement, with excellent improvement in flow.
    The middle lesions were not dilated due to concern for dissection. Wire
    was then advanced and attention was focused to the tibioperoneal
    disease.
    9. The tibioperoneal trunk was crossed with an 0.014 wire and
    significant attempt was made to cross into the anterior tibial artery.
    This was not successful. The wire was placed in the peroneal artery and
    then using the 4 mm balloon this was dilated and subsequently a 4 x 60
    I-
    DEV stent was then delivered to the tibioperoneal trunk with excellent
    results. Marked improvement was noted in the distal extremity as well
    and at this point the entire assembly was removed. No complications
    occurred.

    FINAL RESULTS:
    1. Successful percutaneous transluminal angioplasty of the left
    superficial femoral artery with 4 mm balloon with stenosis reduction
    from 95% to less than 40%.
    2. Successful percutaneous transluminal angioplasty and stenting of the
    tibioperoneal trunk using I-DEV 4 x 60 stent with stenosis reduction
    from 90% to less than 20%.

    Is it appropriate to code this as: 37224, 37230, 75716-26-59, 75625-26?
    That's the way I would code the case.

    Jim Pawloski, CIRCC

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