# Help with CPT codes



## Julia Davenport (Mar 20, 2008)

I need a little help with some CPT code choices. 
What I have so far is 36247/36248/75962/75710/g0269 +conscious sedation
the insurance (HMA) denied the 75710 with the denial of " this procedure should not be billed separately as it is integral to the primary procedure." We billed it with the 59 and they still denied it. Here is the report......
PROCEDURE:
1. Left lower extremity run-off examination.
2. Selective angiography of left posterior tibial artery.
3. Cryoplasty of proximal left posterior tibial artery.
4. Cryoplasty of left mid posterior tibial artery.
5. Conscious sedation x 121 minutes.

INDICATIONS: LT TOE GANGRENE

COMPARISON: Advanced Imaging Northwest , MR, ANGIO RUNOFF (PNL), 11/16/2007, 7:53.

TECHNIQUE: Informed written consent from the patient was obtained prior to the procedure. Patient was brought to the angiography suite, and conscious sedation was administered intravenously while continuous cardiorespiratory monitoring was performed. Bilateral groins were prepped and draped sterilely, left groin was infused with lidocaine. Left common femoral artery was accessed antegrade with the micropuncture set and was injected for left lower extremity run-off examination. An 0.035 glidewire
was then advanced into the left popliteal artery and a 3-French Renegade high-flow catheter was advanced over an 0.014 microwire into the left posterior tibial artery and was injected for selective left posterior artery angiography. Intraarterial pressure gradients were measured across the left posterior tibial artery.
Subsequently, a 2.5 mm diameter cryoplasty balloon was advanced into the left mid posterior tibial artery and was expanded. Subsequently, the cryoplasty balloon was withdrawn into the left proximal posterior tibial artery and was expanded. This was followed by repeat angiography. 300 micrograms intraatrial nitroglycerin were administered. Cryoplasty balloon was then readvanced into the left mid posterior tibial
artery and re-expanded. Cryoplasty balloon was then withdrawn into the proximal left posterior tibial artery and re-expanded. 200 micrograms intraarterial nitroglycerin was administered. Repeat angiography was performed. Subsequently a 2.5 mm diameter conventional angioplasty balloon was then advanced into the left mid posterior tibial artery and was expanded followed by repeat arteriography. The conventional 2.5 mm angioplasty balloon was then advanced into the left proximal posterior tibial artery
and was expanded to 2.8 mm diameter, followed by repeat angiography. Oral aspirin and loading dose of Plavix was administered following the procedure.

FINDINGS: The left common, profunda, and superficial femoral arteries demonstrate mild diffuse stenosis. Above-knee popliteal artery demonstrates a mild focal stenosis at the level of the top of the femoral condyles. Above and below-knee popliteal artery is otherwise mildly diffusely stenotic. The anterior tibial artery occludes in the proximal calf. Tibial peroneal trunk mildly diffusely stenotic. Peroneal artery occluded, and reconstitutes distally. Posterior tibial artery demonstrates multifocal moderate to high grade radiographic stenoses within the proximal and mid portions across which significant intraaterial pressure gradients were measured.Following initial cryoplasty of the left mid posterior tibial artery there is severe diffuse residual stenosis, presumably reflecting spasm. Following intraatrial nitroglycerin administration, as well as repeat cryoplasty and conventional 2.5 mm angioplasty of the left mid posterior tibial artery, no residual stenosis is present. Following initial cryoplasty of the left proximal posterior tibial artery there is mild residual stenosis with superimposed focal residual high-grade focal stenosis, roughly 7 cm distal to the origin. Following repeat cryoplasty, intraatrial nitroglycerin administration and conventional angioplasty at this location, there is
only mild focal residual stenosis.

IMPRESSION:
1. Status post 2.5 mm diameter cryoplasty of hemodynamically significant stenosis within proximal left posterior tibial artery, with only mild residual stenosis.
2. Status post 2.5 mm diameter cryoplasty of left mid posterior tibial artery for treatment of
hemodynamically significant stenosis with no residual stenosis.
3. Oral Plavix therapy initiated.
4. Follow up Doppler ultrasound of left lower extremity will be scheduled for the patient


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## MLS2 (Jul 10, 2008)

I think I'm reading this right, it sounds like all the angioplasties were done in the left "posterior tibial artery" just in different parts of it (mid, proximal, etc...)  As long as they're all in the same vessel, it's one angioplasty.  If it was anterior and posterior tibials, then you could do 2 angioplasties.
I would do a 75710-59, 36247, 75962, 35470.  Sedation would be included in the angioplasty.  Make sure that your arteriogram guidelines are also met.
Hope this helps!


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