# Abdominal and LE angio help needed.



## Robbin109 (Jul 29, 2012)

*My co-worker and I are disagreeing on this one:*

Procedures Performed:

1. Abdominal Aortogram
2. Nonselective renal angiogram.
3. Iliac angiogram
4. Right lower extremity angiogram with catheter placed in the right proximal superficial femoral artery.
5. Left lower extremity angiogram with a catheter placed at the level of teh left common femoral artery.

Technique:

A 5-French sheath was inserted into the left common femoral artery after access was gained using the micropuncture technique.

Catheters used were 5-French Omni Flush catheter

this was place at the level of the renal arteries and 20 ml of contrast was then injected at 10mL/second.  The findings were as follows: There ware 3 right renal arteries and there was 1 main left renal artery.  They were all free of any significant disease.  The abdominal aorta was normal caliber.

Iliac angiogram showed that both common iliac and external iliac arteries were free of any significant disease.

Both the internal iliac arteries were free of any significant disease.

Right lower extremity angiogram: The right common femoral, the right SFA, the right profunda, the right popliteal artery, the right  TP trunk, right posterior tibial artery were free of significant disease.  The right anterior tibial artery had about 50% stenosis in it mid portion.  The right distal anterior tibial artery was completely occluded, but then the right dorsalis pedis vessel was reconstituted. the posterior tibial artery was divided into medial and lateral branches.  They were small vessels, but multiple collaterals were seen going via the metatarsal arteries towards the toes.  The peroneal artery supplied all the way up to the ankle and fave a calcaneal branch which was patent. The posterior tibial artery also gave a calcaneal branch which was small but patent. 

Findings:
On the left side, the left lower extremity angiogram showed that the left common femoral, profunda SFA, popliteal, anterior tibial, posterior tibial, and peroneal were free of any significant disease.  The distal anterior tibial, right at the level of the dorsalis pedis has about 80% stenosis more distally.  There was a 3-vessel runoff to the foot.

Final Impression:
1. Bilateral 3-vessel runoff.
2. Occluded distal anterior tibial but reconstituted posterior tibial artery. 
3. Severe focal lesion of the left anterior tibial artery.  Eccentric stenosis of the left anterior tibial-dorsalis pedis junction up to about 80% to 90% stenosis.

Based on teh above and given the fact that the patient had an excellent TCP02 on the right foot, it was decided to leave the patient alone for medical therapy.


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## Triachcpc (Jul 29, 2012)

Hi, Robin.  My coding would be as follows:

Abdominal Aortogram 75625 (includes the renal findings as same was not selective)
Bilateral Extremity 75716
Third Order Selective Cath Placement 36247 (for contralateral cath placement into the Rt SFA)

Pull back catheter injections into the left aren't coded (site of access) and I don't see where any additional selective placements were made to warrant 75774.  Hope this helps and I didn't cause any more confusion!  Isn't IR coding fun!!


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## Robbin109 (Jul 30, 2012)

Yes, it its. It's keeping me on my toes. 

Thanks!


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