# need help please, new to this..



## bevann0402@bellsouth.net (Jun 3, 2014)

indication: life-style limiting claudication, abnormal CTA of distal aorta with runoff

Procedures performed
1. 6-French sheath placement in right common femoral artery
2. 6 French sheath placement in the left common femoral artery, both without difficulty
3. Distal aortogram with bilateral lower extremity runoff
4. Percutaneous transluminal angioplasty with stenting of the right common iliac artery
5. Percutaneous transluminal angioplasty with stenting of left common iliac artery, both performed in simultaneous kissing balloon deployment fashion, as well as kissing stent fashion
6. Percutaneous transluminal angioplasty with stenting of the left external iliac artery

Procedure:
the details of lower extremity angiography and PTA were explained to the patient in great detail including risk factors.  Formal consents were signed and witnessed. She was prepped and draped in usual sterile fashion.  She underwent 6 French sheath placement in the right common femoral w/o difficulty. She underwent 6 French sheath placed in the left common femoral w/o difficulty. A pigtail catheter was placed into the distal aorta and distal aortogram with bilateral lower extremity runoff was performed. The distal aorta is heavily calcified. Ther is 40% stenosis just above the carina. The right common iliac artery had an 80% lesion. The left external iliac artery has a 90% lesion. There was a 70% lesion seen in the left external iliac artery. Bilateral common femoral arteries are calcified with mild plaquing, and we saw a 50% to 60% stenosis on the bilateral superficial femoral arteries on the runoff.

The decision was made to perform kissing stent balloon inflations to go on to perform kissing stent placement to the bilateral common iliac arteries and to the distal aorta to rebuild the carina.

first, we started by changing out the 6 French short sheath to 7 rench 23 long sheaths in both the right and the common femoral arteries. These were left hanging out of the groin bilaterally just to allow us enough room to performe our iliac interventions. Angiomax was started. next, we took two 5 x 20 Mustang balloons. we placed them across the bilateral iliac arteries into the distal aorta and simultaneous inflations were performed up to 12 atmospheres for 15 seconds. both were removed from the body, angiography showing improvement. next we took two 7 x 40 everflex stents, these were placed across the distal aorta into the bilateral common iliac arteries and they were self deployed stents. the 80% lesion on the right and the 90% lesions in the left common iliac artery both reduced to less than 10%.

next we returned our attention to the severe lesion in the left external iliac artery with appeared to be about 70%. we predilated the lesion with 5 x 20 mustang balloon at 10 atmospherres x 2 in overlapping fashion. next we took a 7 x 40 everflex stent placed it across the predilated lesion in the left external iliac artery and then we deployed this up to 12 atmospheres for 20 seconds. we went on to post the stent with the 5 x 20 mustand balloon and this was up to 12 atmosphers for 20 seconds as well. final angiography was performed with and without wire in place. seeing less than 10% residual to the bilateral common iliac arteries without any damage to the distal aorta. no evidence of dissection or distal embolization. the 70% lesion in the left external iliac artery is reduced to less than 20%. patient left lab in stable condition.

any help on codes is greatly appreciated as I am new to the cardiology side of things.

Thanks
Beverly, CPC


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## Jim Pawloski (Jun 4, 2014)

bevann0402@bellsouth.net said:


> indication: life-style limiting claudication, abnormal CTA of distal aorta with runoff
> 
> Procedures performed
> 1. 6-French sheath placement in right common femoral artery
> ...



I would code:
37221-RT
37221-LT-59

Because of the CTA, I would not code 75716 for the bilateral lower extremity angio.
HTH,
Jim Pawloski, CIRCC


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## bevann0402@bellsouth.net (Jun 4, 2014)

Thanks, trying to find my way in this new world of cardiology.  Just now getting the hang of my general surgeon, now this!! lol

have great day!
Beverly


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## SEARNEST (Jun 12, 2014)

I think you may also want to bill for the external iliac stent:

37221-RT (common iliac)
37221-LT-59 (common iliac)
37223-LT (external iliac)


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## bevann0402@bellsouth.net (Jun 12, 2014)

thanks


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