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Thread: Cerebral Angioplasty

  1. #1
    Join Date
    Apr 2007

    Default Cerebral Angioplasty

    AAPC: Back to School
    Hi , Please code this report......

    Cerebral angiogram and angioplasty

    Clinical: right common carotid artery symptomatic restenosis in a
    Patient with history of laryngeal carcinoma status post neck
    Radiation and carotid stent placement

    Following discussion of risks and benefits and alternatives, informed
    Consent for these procedures was obtained from the patient through an
    Interpreter. The procedures were performed under conscious sedation .
    The patient was monitored throughout for ekg, blood pressure, and
    Pulse oximetry. Then using standard techniques and a right common
    Femoral approach a six french sheath was placed. After gaining
    Vascular access at baseline act was drawn and followed throughout the
    Case. Next a 6 french 90 cm envoy catheter was used for selective
    Injections of right common carotid artery.

    Right common carotid injections:
    Ap, lateral and oblique views of the neck and skull base were
    Obtained. Once again, there is an area of approximately 75 to 80%
    Stenosis noted adjacent to the proximal aspect of the stent.
    Additionally, there is an area of focal mid stent restenosis with a
    Luminal stenosis of approximately 60 to 70% . The carotid bifurcation
    Is widely patent. The visualized proximal eca and ica are
    Unremarkable. There are visualize surgical clips adjacent to the
    After selecting the appropriate working views a transcend exchange
    Microwire was advanced past the stent restenosis using a rapid
    Transit microcatheter. The microwire was advanced to the distal
    Cervical internal carotid artery and the microcatheter was then
    A aviator 5 mm x 20 mm angioplasty balloon was prepared according to
    Manufacture guidelines. The patient was given a bolus of heparin and
    Started on heparin drip.
    Right common caroitd artery angioplasties:
    The balloon was then navigated across the proximal adjacent stent
    Stenosis under continuous fluoroscopy and roadmap conditions. Once in
    Optimal position the balloon was slowly inflated to 10 atmospheres
    Under timed conditions. The balloon was then deflated and pulled back
    Into the base catheter. Dsa runs were then obtained.
    Repeat right common carotid artery injection:
    There has been significant improvement in the proximal stenotic
    Region. Lateral image of evaluation is limited by shoulder mass, but
    Ap fluoroscopic runs demonstrate no residual luminal stenosis. A
    Microwire is stable in position. The parent vessel is widely patent.
    There is no evidence of dissection.
    Right common carotid artery angioplasty:
    The aviator 5 mm x 20 mm angioplasty balloon was once again advanced
    Over the wire now more distally to the area of maximal in stent
    Restenosis. Once in optimal position the balloon was inflated to 8
    Atmospheres under timed conditions. The balloon was then deflated and
    Removed. Dsa runs were then obtained.
    Right common carotid artery injection:
    There has been significant improvement in the angioplasted stenotic
    Segment. There is less than 50% residual luminal stenosis. A
    Microwire is stable in position. There is no evidence of vessel
    Delayed common carotid artery injection:
    Views over the head and neck were obtained. The angioplasty segments
    Are widely patent. There is no evidence of platelet aggregation or
    Filling defect. Views of the head were then obtained. The internal
    Carotid artery is widely patent. There is significantly improved
    Filling of the aca and mca. There is continued narrowing at the
    Origin of the right a1. There is flash filling of the external
    Circulation. There is no evidence of vessel cutoff or filling defect
    To suggest embolic event.
    The microwire was removed under continuous fluoroscopy to insure that
    The stent is not disrupted.
    The catheter was removed and then the sheath left in place. The
    Heparin drip was left running overnight and discontinued in the
    Morning. The patient was taken to a hospital bed for routine post
    Procedure observation and care. There were no apparent complications.

    1. Approximately 75 to 80% proximal common carotid artery stenosis
    Adjacent to right cca stent.
    2. Approximately 60 to 70% mid in-stent restenosis.
    3. Status post angioplasty of proximal cca stenosis without residual
    4. Status post angioplasty of mid in-stent restenosis with <50%
    Residual stenosis.

    HariHaran CPC

  2. #2



    I arrived with this answers

    36217-Cath gone upto internal carotid artery
    75676- S&I
    35475-Angioplasty intra stent stenosis

    What are your answers Hari, Share me ur ans


  3. #3


    you will also need a -59 modifier to unbundle the angioplasty.

  4. #4
    Join Date
    Apr 2007


    Ya its correct except 36216 since only the microwire is advanced in to the cervical ica for supporting purposes, we cannot take this one as selective cathertization and 59 for 75676....
    Last edited by Hariharan; 09-09-2008 at 03:44 AM.

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