That's the way I would code the case.PROCEDURE PERFORMED:
1. Peripheral arteriogram with bilateral lower extremity runoff.
2. Percutaneous transluminal angioplasty of the proximal superficial
3. Percutaneous transluminal angioplasty and stenting of the left
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.
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
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
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
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?
Jim Pawloski, CIRCC
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