# Peripheral Angio + PTA



## amym (Feb 7, 2012)

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 
   artery. 

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. 

Findings: 
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. 

Impression: 

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.


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## jmcpolin (Feb 7, 2012)

you would not code the 36200 because the catheter ended up in the contralateral SFA


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## Jim Pawloski (Feb 7, 2012)

jmcpolin said:


> 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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