# iliac angio with runoff



## csorensen21@yahoo.com (Oct 7, 2013)

Can someone please help with this I am brand new to interventional radiology coding??!!

Procedure:
1. Selective left common iliac angiography with runoff
2. Selective left superficial femoral artery angiography with digital subtraction imaging
3. successful but technically demanding recannulization of chronic total occlusion of the distal superficial femoral artery with stent implantation.

Indication: severe claudication symptoms, abnormal CTA aortogram with runoff.

Consents were signed and risks and benefits and alternatives of therapy fully discussed with the patient in the office.

Patient was prepped according to protocol. We draped both groins and axis was obtained from the right femoral artery using 6 French sheath. Then subsequently we used a judkins right catheter that engaged the origin of the left common iliac artery and selective angiography was performed. Then using a Glidewire the catheter was advanced into the common femoral artery and selective angiography was performed with runoff. Then subsequent to that we use a Glidewire and exchanged the sheath into a long 45 cm sheath that was advanced to the left common femoral artery.

We attempted to advance the glidewire without success through a chronic total occlusion then I attempted the glide catheter were also limited success. Then we used a pilot 150 coronary wire 0.14 inch and weighed maneuvering we were able to cross the lesion then wire was exchanged through the glide catheter with a terumo gold wire. Initially 40 balloon was attempted to cross the lesion without success so we substituted death with 3 or coronary balloon that created a small tract with occlusion then subsequently reused for coronary balloon followed by a peripheral balloons and multiple inflations were performed and the lesion appears to have been extending from the distal superficial femoral artery at the level of the abductor canal all the way to the proximal popliteal artery. Despite multiple prolonged inflations the lesion appears to have high recoil and significant dissection flap was noted.  So the decision was made to place stents a 5mm x 100mm stents self expanding was deployed post stent deployment balloon inflations using 4.0 millimeter and a 5.0 millimeter balloons to guarantee complete opposition of the stent was performed with excellent results and without any immediate problems complete restoration of distal flow was noted with excellent results and without any immediate problems complete restoration of distal flow was noted with excellent run off without any limitation on the three-vessel runoff distally.

Any help would be very much appreciated! 

Thank you!


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## Jim Pawloski (Oct 7, 2013)

csorensen21@yahoo.com said:


> Can someone please help with this I am brand new to interventional radiology coding??!!
> 
> Procedure:
> 1. Selective left common iliac angiography with runoff
> ...



What you have is a left lower extremity arteriogram (75710), then the superficial femoral artery was opened with a stent.  The angioplasty is bundled in the stent placement, along with catheter placement.  The code for stent placement in the femoral-popliteal region is 37226.  So your codes are 37226, 75710.
HTH,
Jim Pawloski, R.T.(CV), CIRCC


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## csorensen21@yahoo.com (Oct 8, 2013)

Thank  you Jim! I was thinking that it was 37226 but I just wanted to make sure. I need to stop second guessing myself with my codes!


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