# Abdominal aortogram w/ bilateral iliac angiography



## mekelly (Feb 25, 2014)

I am stuck self teaching myself cardiology coding and I just can't get the hang of coding legs! Can someone guide me on this one please? Also, if there are any good resources to help teach me this I would appreciate the help! Thanks in advance. 

PROCEDURE: Abdominal aortogram with bilateral iliac angiography, selective angiography of the left femoral, and angiography of the left and right leg.

INDICATION: Arterial ulcers in the left leg with life-limiting claudication and severely reduced ABI.

PROCEDURE IN DETAIL: After informed consent, the patient was brought to the cardiac cath lab where she was prepped and draped in the usual sterile fashion. The right groing was infiltrated with 10 ml of 1% lidocaine for local anesthesia. Via the percutaneous technique, arterial access was obtained and a 6-French arterial sheath was placed without difficulty. A Contra catheter was advanced over a guidewire into the abdominal aorta and abdominal aortogram was performed. The Contra catheter was the brought down to the distal aorta just above the bifurcation and angiogram of the iliac vessels was performed. A RIM catheter was then used to cannulate the left common iliac and a Glidewire was advanced into the femoral vessel, and the RIM catheter was advanced over the Glidewire. Angiogram was performed of the common femoral and profunda; then a long-leg angiogram of the left leg was performed. The RIM catheter was withdrawn over a guidewire and angiogram through the sheath was performed, and angiogram of the right leg was then performed. There is severe bilateral iliac stenosis with a 37 mm gradient on the left between the aorta and the left common femoral. Decision was made to proceed with endovascular therapy. The left groing was then infiltrated with 10 ml of 1% lidocaine for local anesthesia. Via the percutaneous technique, arterial acess was performed and a 6-French 23 cm Bright-Tip was advanced over a guidewire into the distal left common iliac. The short sheath on the right was exchanged for a 23 cm Bright-Tip sheath and this was placed in the right common iliac. Rosen wires were placed bilaterally and left in the aorta. The lesion in the left comon iliac was predilated with a 5 x 20 balloon and a 7 x 20 balloon. The lesion on the right was predilated with a 7 x 20 balloon. Then, 7 x 29 balloon expandable stents were deployed simultaneously in the right common iliac and the left common iliac. There was residula stenosis and pressure gradient in the right and the lesion was postdilated with a 7 x 20 balloon. The 80% stenosis in the right common iliac was reduced to a 10% residual stenosis. The 70 % stenosis in the left common iliac was reduced to 10% resudual stenosis. Attention was then turned to the severe stenosis in the left external iliac. A 7 x 40 self-expanding stent was then deployed and postdilated by the 7 x 20 balloon. The 70% stenosis was reduced to 10% residual stenosis. The patient was anticoagulated with intravenous heparin and ACTs were monitored. There was a 10 mm residual pressure gradient on the left on pullback with no significant pressure gradient noted on the right.

FINDINGS: There is mild plaque in the infrarenal abdominal aorta without significant stenosis. The left renal artery is widely patient. The right renal artery has a 10% distal stenosis. The right common iliac has a calcified 80% stenosis pre-angioplasty and stent placement. The left has a 70% calcified stenosis pre-angioplasty and stent placement. The left external iliac has a discrete 70% stenosis pre-angioplasty and stent placement. The left internal iliac is 100% occluded. The right external iliac has mild nonobstructive plaue. The right internal iliac has a 70% proximal stenosis and moderate plaque in the mid to distal vessel. The left common femoral has 50% stenosis. The right common femoral has a 70% stenosis at the sheath insertion, as well as a 50% in the distal external iliac and proximal common femoral. The left superficial femoral just above the knee. The popliteal has proximal 50% stenosis. The anterior tibial is patent into the foot. The posterior tibial is occluded in its proximal portion and reconstitutes at the ankle. The peroneal is patent on the left. The right superficial femoral is occluded in its ostial portion. The profunda is widely patent. The SFA reconstitiutes just above the knee at Hunters canal. There is a 70% popliteal stenosis. The anterior tibial, tibioperoneal trunk, peroneal and posterior tibial are all patent. There is mild nonobstructive disease. 

IMPRESSION:
1. 7 x 29 balloon expandable stent to the right and left common iliac and 7 x 40 self-expanding stent to the left external iliac. 
2. Bilateral 100% occlusion of the superficial fmeoral with 3-vessel runoff on the right and single-vessel runoff on the left with reconstitiution of the posterior tibial at the level of the ankle.


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## hopeslove (Mar 24, 2014)

http://www.articlesbase.com/health-...-extremity-angiography-confusion-5726386.html

This link helped me, I hope it does the same for you 

Hope


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## Jim Pawloski (Mar 24, 2014)

mekelly said:


> I am stuck self teaching myself cardiology coding and I just can't get the hang of coding legs! Can someone guide me on this one please? Also, if there are any good resources to help teach me this I would appreciate the help! Thanks in advance.
> 
> PROCEDURE: Abdominal aortogram with bilateral iliac angiography, selective angiography of the left femoral, and angiography of the left and right leg.
> 
> ...




On this case, for the imaging, you have 75625 and 75716.  When the intervention occurs in the lower extremities, the catheters go away,but you still have your imaging codes.  The revascularization codes are 37221 and use the modifier -50 or -rt and -lt, depending on payer for the common iliac stents, and 37223-lt for the external iliac stent.

HTH,
Jim Pawloski, CIRCC


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