# Peripheral atherectomy and angioplasty



## 10marty (Sep 30, 2010)

Procedures Performed:
R femoral angiography with S&I
Balloon dilatation to the distal SFA
Balloon dilatation to the popliteal artery
Suboptimal balloon result with Fox Hollow atherectomy of the distal SFA

Report as follows:
Attempt to go through the right common femoral with antegrade stick unsuccessful given to fat tissue.  Went thru the L groin, retrograde stick with a crossover using rim catheter with a glide wire.  The glide was placed in the distal SFA and the rim catheter advanced and using Amplatz extra stiff placed a sheath crossed over to the proximal RSFA.  With wires pushed into the distal vessel and reconstituted the distal SFA which was 100% stenosed with collaterals.  After transcatheter going with a filter wire, spider placed distally distal to the popliteal in the peroneal tibial trunk and deployed successfully.  We started with a 2x40 mm balloon and with multiple dilatation was obtained.  Using a Fox atherectomy device, multiple rotational atherectomy was done in the distal SFA.  After looking at the picture, a second 2.5 balloon and finally a 5x14 cm balloon was placed and inflated to 8 atm's for final dication.  Final results showed no proximal distal dissection, TIMI III flow and minimal residual stenosis.

Can I bill:
36247 L Popliteal
75710-26
35474 LSFA
75962-26
35493 LSFA
75992-26

Any thoughts?  Can peripheral atherectomy and angioplasty be billed together?  Is this dependent on the payor? If so, which ones?

Thanks for any insight.  MJ


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## theresa.dix@tennova.com (Oct 1, 2010)

Marty,
 In this case I would only code the atherectomy as far as the intervention goes. Not the angioplasty. I dont see anywhere in the report that says Angioplasty was suboptimal. 

The rest of your codes look good.


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