# Lower extremity coding, I am very new and confused with lower extremity.



## rconpatton (Feb 26, 2015)

Procedures Performed:
Selective right iliac angiography with runoff via the right groin
Selective left iliac angiography with runoff
PTA attempt of the left external iliac, left common femoral artery, left SFA


Description of procedure:
The right femoral artery was cannulated with an initial stick without any difficulty. Right iliac angiography with runoff was initially performed through the sheath. A 6 French short IMA guide was then used to cross into the left iliac system and angiography was performed of the iliac system with runoff. It was noted that the distal external iliac proximal segments of the profunda as well as the SFA. The distal SFA and below the knee circulation was not very clear. It was decided to proceed with a PTA attempt of the external iliac artery and assess the calcium burden in the femoral artery. Initially, an attempt was made to use a Wholey wire without success. Glide-wire was then used, which crossed into the distal external iliac artery and a 4 French angled glide catheter was used to advance through the proximal calf. This was done without much difficulty. However, the Glide-wire could not be advanced ino the femoral artery. This was then exchanged for a Runthrough wire with some success and then with a Victory 25G/300 cm wire which actually crossed not only the occluded external iliac, but the occluded femoral artery and the proximal segment of the occluded profunda. Attempts were made to cross into the proximal SFA and this could be done once; however, the 4 French angled glide catheter kept prolapsing the wire into the profunda. This was then exchanged for a 5 French straight glide catheter. It was felt that the proximal SFA as well as the femoral artery stenosis was extremely calcified and for concern of dislodging this plaque into collateral's and into the profunda, it was felt that this patient's best treatment option even though the femoral stenosis was crossed, would be endarterectomy with patch angioplasty. After crossing the lesion with a wire and the glide catheter, the flow was improved in both the profunda and the SFA and the distal circulation could be visualized which seems like there is flow in at least 2 out of 3 vessels below the knee. At then end of the procedure, the 7 French glide catheter was exchanged for an 8 French sheath. No obvious complication occurred. The patient left the Cardiac Cath Lab in stable condition.

I am fairly new, I thought I had it but I always second guess myself with these type of procedure. I give thanks in advance for any type of help.
Rach


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## j.monday7814 (Feb 26, 2015)

I definitely want to help but I don't want to just give away the codes either. what codes did you get?


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## rconpatton (Feb 26, 2015)

I understand learning process, the codes I came up with:
36245
36246
75710-26
37220-52 Dr wanted me to still bill for at least attempting.

I'm very new to this type of coding, I would love to learn this. So any sites or books I can buy to help educate myself would be wonderful. Thanks in advance


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## j.monday7814 (Feb 26, 2015)

I would do 37220-53 (patient safety) with 75716 (bilateral instead of unilateral). he gained access in the right femoral, moved to the right iliac and shot contrast (75710), then he crossed the bifurcation into the left iliac and shot contrast again (75710 replaced by 75716). 36245 and 36246 can't be billed during an intervention, since this was attempted and not completed you could have chosen either 36246 (maybe with mod 22) or the 37220 with modifier 52 or 53.

As for reference material I use Dr. Z's Interventional Radiology Coding, it's expensive but the only book you'll need for interventional coding. It includes diagrams and specific coding guidelines in each section.


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## rconpatton (Feb 26, 2015)

Thank you, you really gave me insight on understanding. Where would I go to find the book?


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## espressoguy (Feb 26, 2015)

rconpatton said:


> Thank you, you really gave me insight on understanding. Where would I go to find the book?



Z-Health Publishing


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