37227 Stent and AtherectomyGood day,
I do not normally code cath reports,so one can only imagine how lost I am. Can you please offer any assistance? How would you code this report and can you include your justification for the codes you selected & highlight where? You have no idea how much I appreciate this.
Vessel Angiography Findings
Focal aneurysm distal aorta just proximal to aortic bifurcation
50% calcified focal stenosis left common iliac artery
LEFT LOWER EXTREMITY ANGIOGRAPHY:1
00% ostial occlusion previously stented left SFA with reconstitution at the distal SFA via collaterals from the profunda femoris
Patent popliteal-distal bypass which is anastomosed to the distal AT
100% occlusion of native PT, peroneal and AT proximally with reconstitution of distal AT via pop-distal bypass
1 vessel run off to the foot as described
RIGHT LOWER EXTREMITY ANGIOGRAPHY:
100% occlusion mid segment of previously stented SFA with reconstitution of the distal SFA via collaterals from the profunda femoris
100% occlusion proximal AT and PT with reconstitution of AT at the ankle via collaterals from the peroneal artery
1 vessel run-off via peroneal artery to the foot
Interventional Procedure Details:
Pt was prepped and draped in sterile fashion followed by injection of lidocaine to anesthetize the tissues of the left groin. Access was gained in the common femoral artery on the left and a 4F Brite Tip Sheath was placed. Aortogram with run-off was performed using a 4F UF catheter positioned in the distal aorta. The catheter was then advanced over a guidewire to the contralateral SFA and right lower extremity angiography was then performed. The 4F sheath was exchanged for a 6F 70 cm Cook Ansel Sheath which was positioned with the distal tip in the right common femoral artery. A VIPER wire was advanced into the peroneal artery and orbital atherectomy was performed using a 1.5 Classic Crown Diamondback device in the proximal SFA. The SFA was then dilated using 6.0 mm x 150 mm SAVVY and 6.0 x 40 mm ANGIOSCULPT balloons serially. Flow limiting dissection was noted in areas of the distal and mid and proximal SFA requiring the placement of a 9 mm x 40 PRECISE and 8 x 120 SMART 2, 9x30 mm SMART stent from distal to proximal and post dilated using a 6.0x15mm AVIATOR balloon. Final angiography revealed absence of flow in the single run-off vessel requiring mechanical thrombectomy of the peroneal artery using a PRONTO V3 aspiration device. Final angiograply revealed improved flow through the SFA and peroneal.
37186 secondary mechanical thrombectomy because it is secondary to primary procedure 37227
75635-26 aortagram with run off
75898-26 follow up angio
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