# need some direction on codes please



## bevann0402@bellsouth.net (Jul 17, 2014)

you guys have been so helpful, calling on you once again.

I will list the codes I am coming up with at the end of the report.

Procedures performed:
1. 6 French sheath placement in the left common femoral artery w/o difficulty
2. distal aortogram w/ bilateral lower extremity runoff
3. selective angiography of the left common femoral artery
4. selective angiography of left superficial femoral artery
5. selective angiography of the right common femoral artery
6. selective angiography of the right superficial femoral artery
7. selective angiography of the right popliteal artery
8. filter placement to the right popliteal artery
9. atherectomy of the right superficial femoral artery
10. atherectomy of the right popliteal artery

indication: nonhealing wound claudication, abnormal ABI's, abnormal CTA

patient prepped and underwent 6 French sheath placement in the left common femoral artery w/o difficulty. the pigtail catheter was taken up through the short sheath to the distal aorta, and distal aortogram with runoff was performed. distal aorta shows narrow, tapering mild calcifications, but no significant occlusions.
1. right common iliac artery widely patent
2. right internal iliac artery widely patent
3. right external iliac artery widely patent
4. right common femoral artery diffuse 50% disease
5. right superficial femoral artery 30 to 50% stenosis proximal to mid. the mid vessel becomes 100% occluded. reconstitution of the popliteal artery. patient with 3 vessel runoff to the right foot.

6. left common iliac artery widely patent
7. left internal iliac artery widely patent
8. left common iliac artery widely patent
9. left common femoral artery, 30% diffuse disease
10. left superficial femoral artery multiple tandem lesions approximately 50 to 60%.
11. left popliteal artery widely patent
12. 3 vessel runoff to the left foot.

decision was made to perform angioplasty. the short sheath is removed from the left groin and we place a 7x45 Terumo. we took this down into the right common femoral artery.

selective angiography is then performed. see above for details.  we then started Angiomax.  we used a Grand Slam wire. we wired all the way down into the popliteal artery. we got past the proximal cap.  in the distal cap, the wire became unable to progress.  we took a Viance catheter and quickly passed through the distal cap into the popliteal artery.  Viance catheter is removed from the body.  we took a 5 French filter, placed it into the popliteal artery.

we took a TurboHawk LX-C and we did atherectomy to the right SFA and right popliteal artery in the mid, down into the just proximal popliteal.  at the completion of this, we saw that the vessel was greatly improved, but we took a 5x100 evercross balloon and placed it into the popliteal distal SFA. we inflated up to 4 atmospheres for 4 minutes.  we then deflated it.  we moved the balloon more proximally to overlap it and to get the entire segment which we performed with and without wire in place.  the 100% occlusion to the right superficial femoral artery, right popliteal artery is reduced to less than 20%. there is no evidence of distal embolization, and we saw a 3 vessel runoff to the right foot.  return of pulses was noted by palpation at the end of the exam.  the sheath was sewn into place to the left groin after is was exchanged to a short sheath.  patient left in stable condition.

reading through what all he did, I picked out the following codes, still learning, so there is probably a cpt code that contains all this..

#9 and #10--37225
#2--75630
since he did both right and left, 36246, 36248 and use the LT and RT modifiers
is the filter placement #8 just already included in what has been done?
see my confusion??

thanks so much for any help, it is always greatly appreciated.  Maybe one day I can return the favor!!

Beverly


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## jenneverett (Jul 25, 2014)

*my opinion*

37225 RT atherectomy includes angiogram and agioplasty
36246 LT selective angiogram left leg 
75630-59 abdominal aortogram

37191-59 filter placement includes S&I


He doesn't mention deploying the filter in the report. I would query him to see if it was actually done and if it was add the filter code.

Hope this helps 

Jennifer


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## theresa.dix@tennova.com (Jul 29, 2014)

bevann0402@bellsouth.net said:


> you guys have been so helpful, calling on you once again.
> 
> I will list the codes I am coming up with at the end of the report.
> 
> ...



On this one IMO I would use;

75716-59 angio extremity bilateral. To use 75630  you would need to see cath placement high in the aorta with interpretation of aorta/renals and at least to the femorals. All we have here is interpretation of the legs nothing about aorta or renals.

37225- atherectomy of the fem/pop territory

no cath placements

37191 is for vena cava filter i would not use.

It is early I hope I didnt miss anything! lol


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## bevann0402@bellsouth.net (Jul 29, 2014)

Sorry, haven't been on in awhile.
Thanks for the replies!!!

Beverly


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