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Peripheral Intervention

  1. #1
    Question Peripheral Intervention
    Medical Coding Books
    Is it appropriate to bill this procedure as 37225, 75716-26, 75625-26 or am I missing something?

    PROCEDURE PERFORMED:
    1. Bilateral selective femoropopliteal and intrapopliteal angiography.
    2. PTA of the right SFA.
    3. TurboHawk atherectomy of the right popliteal artery.

    CHIEF COMPLAINT:
    Severe bilateral claudication in this patient with know peripheral
    arterial disease and coronary artery disease who presented who after
    having stenting to the left SFA he was noted to have severe occlusive
    disease below the knee and high-grade stenosis of the SFA bilaterally.
    After his stenting of the left SFA significant improvement in his pain
    was noted in his left leg by opening the inflow, following which now he
    presents to have significant claudication in the right leg, which
    remains.

    PROTOCOL: The patient was brought to the endovascular lab and prepped
    and draped in the usual sterile fashion. Xylocaine was infiltrated and
    both groins were prepped. The left femoral artery was cannulated
    without difficulty and a J-wire was advanced and an OmniFlush 5-French
    catheter was used to advance a Stiff glidewire was used to cross over to
    the contralateral side. At this point, using the left femoral sheath,
    angiography of the left popliteal artery was performed all the way to
    the popliteal artery and it was noted to be the left SFA stent is widely
    patent with good flow, however, the flow was slower due to significant
    occlusive intrapopliteal disease.

    After the identification, a 7-French Pinnacle Destination sheath was
    then advanced and crossed over to the contralateral side with placement
    of the tip at the contralateral femoral artery and at this point images
    were performed and showed multiple areas of stenosis in the SFA on the
    right side. The proximal third of the lesion was 50 to 60%, the middle
    third the lesion was 60 to 70% and the distal third lesion was 90%.
    Immediately below the SFA, the popliteal artery had a focal discrete 90%
    stenosis, which was leading up to having a disease trifurcation with
    occlusive disease involving all three intrapopliteal vessels with
    collateral network, which was faint.

    After lesions were identified, it was felt the most appropriate approach
    would be a TurboHawk atherectomy involving these two lesions. At this
    point, 0.014 Spartacore wire was then advanced and the lesion was
    crossed and the wire tip was placed above the trifurcation and the Ellis
    TurboHawk catheter was advanced but at the level of the distal third
    where there was severe stenosis of the SFA, the TurboHawk could not be
    advanced and therefore was removed. At this point, a 4 x 80 Ampherion
    Medtronic balloon was then advanced and dilated to 6 atmospheres and
    full extension was noted. This was a calcified lesion. After two
    balloon inflations, marked improvement was noted up to a maximum of 6
    atmospheres with no residual narrowing. There is thrombus or
    dissection. There was a mild residual narrowing present. The balloon
    was removed and the Turbo Hawk catheter was now successfully advanced
    into the popliteal artery stenosis, which was treated with multiple
    passes of TurboHawk atherectomy. Two separate runs were done and a
    large amount of plaque was removed, revealing smooth margins and an
    excellent flow with only then 20% residual narrowing at this lesion site
    and at that point, imaging of the intrapopliteal vessels shows no
    changes in anatomy. At this point the entire assembly was removed and
    ProGlide Perclose device was used for closure, which was successful and
    no complications occurred. Final pulses interrogated with Doppler in
    both dorsalis pedis, which were unchanged prior to the start of the
    procedure.

    IMPRESSION:

    1. SUCCESSFUL PTA OF THE DISTAL THIRD OF THE SFA USING 4 X 80 AMPHERION
    BALLOON WITH A STENOSIS REDUCTION FROM 90% TO LESS THAN 20%.

    2. SUCCESSFUL TURBOHAWK ATHERECTOMY OF THE RIGHT POPLITEAL ARTERY WITH
    MULTIPLE PASSES USING ELLIS DEVICE WITH LESION REDUCTION FROM 90% TO
    LESS THAN 20% WITH ATHERECTOMY ALONE.

    Thanks.

  2. #2
    Location
    Alexandria, LA
    Posts
    518
    Default
    You'll really need to clarify with the physician about 75625 and 75716. It appears that this patient has had previous angiography that identified the stenoses. CPT tells us that if there has been previous angiography you can only code it again if the patient's condition has changed, the previous angiogram wasn't sufficiently detailed or there is a change in the patient's condition during the intervention that requires imaging outside the area of therapy.

  3. #3
    Location
    Richardson, TX
    Posts
    822
    Default
    Quote Originally Posted by amym View Post
    Is it appropriate to bill this procedure as 37225, 75716-26, 75625-26 or am I missing something?

    PROCEDURE PERFORMED:
    1. Bilateral selective femoropopliteal and intrapopliteal angiography.
    2. PTA of the right SFA.
    3. TurboHawk atherectomy of the right popliteal artery.

    CHIEF COMPLAINT:
    Severe bilateral claudication in this patient with know peripheral
    arterial disease and coronary artery disease who presented who after
    having stenting to the left SFA he was noted to have severe occlusive
    disease below the knee and high-grade stenosis of the SFA bilaterally.
    After his stenting of the left SFA significant improvement in his pain
    was noted in his left leg by opening the inflow, following which now he
    presents to have significant claudication in the right leg, which
    remains.

    PROTOCOL: The patient was brought to the endovascular lab and prepped
    and draped in the usual sterile fashion. Xylocaine was infiltrated and
    both groins were prepped. The left femoral artery was cannulated
    without difficulty and a J-wire was advanced and an OmniFlush 5-French
    catheter was used to advance a Stiff glidewire was used to cross over to
    the contralateral side. At this point, using the left femoral sheath,
    angiography of the left popliteal artery was performed all the way to
    the popliteal artery and it was noted to be the left SFA stent is widely
    patent with good flow, however, the flow was slower due to significant
    occlusive intrapopliteal disease.

    After the identification, a 7-French Pinnacle Destination sheath was
    then advanced and crossed over to the contralateral side with placement
    of the tip at the contralateral femoral artery and at this point images
    were performed and showed multiple areas of stenosis in the SFA on the
    right side. The proximal third of the lesion was 50 to 60%, the middle
    third the lesion was 60 to 70% and the distal third lesion was 90%.
    Immediately below the SFA, the popliteal artery had a focal discrete 90%
    stenosis, which was leading up to having a disease trifurcation with
    occlusive disease involving all three intrapopliteal vessels with
    collateral network, which was faint.

    After lesions were identified, it was felt the most appropriate approach
    would be a TurboHawk atherectomy involving these two lesions. At this
    point, 0.014 Spartacore wire was then advanced and the lesion was
    crossed and the wire tip was placed above the trifurcation and the Ellis
    TurboHawk catheter was advanced but at the level of the distal third
    where there was severe stenosis of the SFA, the TurboHawk could not be
    advanced and therefore was removed. At this point, a 4 x 80 Ampherion
    Medtronic balloon was then advanced and dilated to 6 atmospheres and
    full extension was noted. This was a calcified lesion. After two
    balloon inflations, marked improvement was noted up to a maximum of 6
    atmospheres with no residual narrowing. There is thrombus or
    dissection. There was a mild residual narrowing present. The balloon
    was removed and the Turbo Hawk catheter was now successfully advanced
    into the popliteal artery stenosis, which was treated with multiple
    passes of TurboHawk atherectomy. Two separate runs were done and a
    large amount of plaque was removed, revealing smooth margins and an
    excellent flow with only then 20% residual narrowing at this lesion site
    and at that point, imaging of the intrapopliteal vessels shows no
    changes in anatomy. At this point the entire assembly was removed and
    ProGlide Perclose device was used for closure, which was successful and
    no complications occurred. Final pulses interrogated with Doppler in
    both dorsalis pedis, which were unchanged prior to the start of the
    procedure.

    IMPRESSION:

    1. SUCCESSFUL PTA OF THE DISTAL THIRD OF THE SFA USING 4 X 80 AMPHERION
    BALLOON WITH A STENOSIS REDUCTION FROM 90% TO LESS THAN 20%.

    2. SUCCESSFUL TURBOHAWK ATHERECTOMY OF THE RIGHT POPLITEAL ARTERY WITH
    MULTIPLE PASSES USING ELLIS DEVICE WITH LESION REDUCTION FROM 90% TO
    LESS THAN 20% WITH ATHERECTOMY ALONE.

    Thanks.
    If you look at pg 373 in CPT it will outline the rules for billing those codes. If you deem they are billable, you'll need to attach a 59.
    Julie Graham, BA, CPC, CCC

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