# Angioplasty and stenting



## todd5400 (Sep 18, 2009)

I would appreciate opinions please these confuse me!

The right common femoral artery was accessed and dilted to a 6 French sheath which was connected to a flush system.  A catheter was navigated into the left subclavian artery.  DS angiography demonstrates atherosclerotic changes without hemodynamically significant stenosis.  The catheter was advanced into the internal carotid artery and DS angiography performed in multiple projections demonstrates no evidence of aneurysm, AVM, or vasal spasm.  There is filling of the posterior circulation apex of the basilar artery and PCA territories via a P-Com vessel.  Once this was accomplished the catheter was removed and navigated into the left common carotid artery. DS angiography demonstrates no significant disease at the bifurcation.  The catheter was advanced into the internal carotid artery and DS angiography performedin multiple projections no evidence of aneurysm, AVM  or vasal spasm.  The catheter removed and navigated into the left subclavian artery.  DS angiography demonstrates tortuosity without stenosis.  The catheter advanced into the vertebral artery.  DS angiography performed in multiple projects demonstrates an occlusion of the proximal basilar artery just distal to the VB junction.  There is also an occlusion of the proximal basilar artery just distal to the VB junction.  There is also an aneurysmal dilatation noted here. The catheter was removed and navigated into the right subclavian artery. DS angiography demonstrates no disease at the origin of the vertebral artery.  This was selectively catheterized.  DS demonstrates a basilar occlusion.  The catheter was navigated into the vertebral artery.  The stent was navigated past the VB junction to the stenosis and deployed.  Control angiography demonstrates a thrombus in the mid basilar artery.  A mechanical thrombolysis was attempted with the catheter.  TPA was infused for 10 minutes. A persistent clot was still appreciated and a merci device was navigated into the mid basilar artery and clot pulled free.  Angiography showed good flow of the basilar artery

Thanks


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## dpumford (Sep 18, 2009)

I coded but you should go thru and compare what I did to what you did.  I hope I got the lt vs rt correct.  

36216 - Lt internal carotid
74665-26  internal
75676-26 Lt commom 
36216- 59 Lt vertebral
75685-26 vertebral

75716-26-59 for Lt & Rt Subclavian
36217- Rt vertebral
37205-Rt stent
75960-26 
37186 - mechanical thrombolysis

I think that is it!

Don't forget mod 59's. I hope this helps I wish I had time to review this but have to go.


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## Jim Pawloski (Sep 20, 2009)

This is one that I would have someone check with the radiologist about his dictation.  Why would he catheterize and image the left subclavian artery twice?  And the dictation states that the catheter into the internal carotid artery, which make me think that the rt subclavian and rt carotid artery was selected.  So before coding, I think that has to be checked out.  Also, stent placement for intercrainal stenosis is 61635, not the 37205.  The thrombectomy charge should also be 37184 since it's the inital vessel.  I think that the combination of the threads will help you out.


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