# carotid pta/stent help



## aforsythe (Apr 26, 2010)

Looking for advice for coding this procedure.  I appreciate any help that can be given.

After obtaining informed consent, the patient was brought to the cardiac catherterization laboratory and a 5-French arterial sheath was placed in the right common femoral artery.  Subsequent to that a 5-French VTK catherer was selectively placed into the left subcavian artery and a selective left subclavian artery angiography was then performed.  THis demonstrated a widely patent left subclavian artery. Left vertebral artey had antegrade flow. Now, the catheter was placed into the innominate artery and innominate and right subclavian artery angiogram was then performed.  This demonstrates a widel patent innominate and right subclavian artery.  The right common carotid artery was widely patent.  Now, the catheter was advanced and was placed into the right common carotid artery and a selective right carotid diagnostic anfiography was then performed.  This demonstrated a 50% stenosis of the right internal carotid artery.  Right external carotid artey was patent.  Upon intracranial angiography, the right anterior and middle cerebral artery both were well opacified.  Posterior cerebral artery was seen.  Now, the catheter was place4d into the left common carotid artery and a left carotid bifurcation angiogram was then performed.  This demonstrated 80% ulcerated stenosis of the left internal carotid artery.  Left external carotid artery contained 60% stenosis.  On intracranial angiography, left anterior and middle cerebral atrery both were well opacified.  At this point, patient was given IV Angiomax bolus as well as infusion.  Now, the V-Tech catheter was selectively positioned into the left external carotid artery and a supra core wire inserted.  Over this assembly, and 8-French H1 guide catheter was advanced.  It was placed into the left common carotid artery.  After the placement of the guide catheter, EmboSheild NAV 6 filter protection device was placed distal to the stenosis.  THen we performed predilatation of the left internal carotid artery using a 4mm balloon.  Despite predilatation, there was residual 70% stenosis.  Hence, and 8 x 10 x 30 Xact stent was then deployed.  This stent was post dilated.  There was 20% residual stenosis.  There was an excellent angiographic result. There was no evidence of distal embolization.  Filter was retrieved.  The patient was ezamined before, during, and after the procedure for gross neurological examination.


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## Jim Pawloski (Apr 29, 2010)

aforsythe said:


> Looking for advice for coding this procedure.  I appreciate any help that can be given.
> 
> After obtaining informed consent, the patient was brought to the cardiac catherterization laboratory and a 5-French arterial sheath was placed in the right common femoral artery.  Subsequent to that a 5-French VTK catherer was selectively placed into the left subcavian artery and a selective left subclavian artery angiography was then performed.  THis demonstrated a widely patent left subclavian artery. Left vertebral artey had antegrade flow. Now, the catheter was placed into the innominate artery and innominate and right subclavian artery angiogram was then performed.  This demonstrates a widel patent innominate and right subclavian artery.  The right common carotid artery was widely patent.  Now, the catheter was advanced and was placed into the right common carotid artery and a selective right carotid diagnostic anfiography was then performed.  This demonstrated a 50% stenosis of the right internal carotid artery.  Right external carotid artey was patent.  Upon intracranial angiography, the right anterior and middle cerebral artery both were well opacified.  Posterior cerebral artery was seen.  Now, the catheter was place4d into the left common carotid artery and a left carotid bifurcation angiogram was then performed.  This demonstrated 80% ulcerated stenosis of the left internal carotid artery.  Left external carotid artery contained 60% stenosis.  On intracranial angiography, left anterior and middle cerebral atrery both were well opacified.  At this point, patient was given IV Angiomax bolus as well as infusion.  Now, the V-Tech catheter was selectively positioned into the left external carotid artery and a supra core wire inserted.  Over this assembly, and 8-French H1 guide catheter was advanced.  It was placed into the left common carotid artery.  After the placement of the guide catheter, EmboSheild NAV 6 filter protection device was placed distal to the stenosis.  THen we performed predilatation of the left internal carotid artery using a 4mm balloon.  Despite predilatation, there was residual 70% stenosis.  Hence, and 8 x 10 x 30 Xact stent was then deployed.  This stent was post dilated.  There was 20% residual stenosis.  There was an excellent angiographic result. There was no evidence of distal embolization.  Filter was retrieved.  The patient was ezamined before, during, and after the procedure for gross neurological examination.





Looking at this, I would bill:
37215 - Lt carotid stent
36216 - Rcca catheter placement
75676- Unilateral carotid - Rt.
75665 - Unilateral Cerebral - rt
36215 - Lt subclavian catheter position
75710 - Lt subclavian angio.

Remember, the carotid stent charge bundles all codes for the Lt Carotid.  Rt Innomiate can't be charged because the doctor was seeing if the catheter could be advanced.

HTH,
Jim Pawloski,CIRCC, R.T.(CV)


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