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Peripheral Angio + PTA

  1. #1
    Question Peripheral Angio + PTA
    Medical Coding Books
    Is it appropriate to bill this as 37228, 36200, 75716-26-59, 75625-26

    Procedure Performed:
    1. Peripheral arteriogram with bilateral lower extremity runoff.
    2. Percutaneous transluminal angioplasty of the left peroneal

    Protocol: After the patient was brought to the endovascular
    laboratory and prepped and draped in usual fashion, Xylocaine was
    infiltrated in the right groin and using a 5-French sheath, a 5-
    French Omni Flush catheter was advanced and imaging of the aorta was
    done and subsequently catheter was pulled back above the bifurcation
    and lower extremity runoff was performed using 6 mL of contrast with
    a bolus chase method. No complications occurred.

    1. The visualized portion of the aorta and bilateral renal arteries
    is normal.
    2. Common iliac, external iliac, common femoral artery, and
    bilateral SFA show only mild disease.
    3. The right circulation below the knee revealed aggressive disease
    with patency of the right anterior tibial artery which reaches
    all the way to the foot with only minimal disease. The peroneal
    artery is also patent- however, it occludes in the mid segment
    which is filling via collateral flow and faint visualization of
    the posterior tibial artery is also noted by faint collaterals.
    On the left side, the trifurcation area begins to show disease
    popliteal arteries without any disease. However, the anterior
    tibial artery is proximally shows 95% stenosis and then in the
    ostial area and then proximal part is occluded with only faint
    filling. There is only single-vessel runoff at peroneal artery
    visualized and shows a proximal 90% to 95% stenosis which is
    serving as the only vessel to the foot. The anterior tibial and
    posterior tibial artery on the left side are totally occluded
    beyond the proximal third.


    High-grade stenosis with a high-risk lesion in the single-vessel
    runoff to the left foot with a nonhealing ulcer in a patient with
    critical limb ischemia.

    Plan: Based on these findings, recommend percutaneous transluminal
    angioplasty of the peroneal artery.

    PTA protocol: After the lesion is identified, a 6-French
    Destination sheath was then advanced and positioned in the
    contralateral superficial femoral artery and then subsequently using
    0.014 Kinetics guidewire fed over an Invitek inferion 2.0 x 40
    length balloon was advanced to the lesion and dilated at 12
    atmospheres. Excellent results were noted with marked improvement
    with no evidence of dissection. Brisk flow was noted to the distal
    foot and improvement in flow noted into the posterior and to the
    anterior tibial artery, which may serve as a potential target at a
    later date.

    Final Impression: Successful percutaneous transluminal angioplasty
    of the proximal part of the left peroneal artery using 2.0 x 40
    balloon with stenosis reduction from 90% to 30% residual with brisk
    flow to the foot and no complications.

  2. #2
    Salt Lake City
    you would not code the 36200 because the catheter ended up in the contralateral SFA
    Jenifer McPolin CPC, CPMA, RCC

  3. #3
    Quote Originally Posted by jmcpolin View Post
    you would not code the 36200 because the catheter ended up in the contralateral SFA
    And is bundled into the intervention, so there is not catheter code.
    Jim Pawloski, CIRCC

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