# need help for hospital billing for cpt 36247



## bhargavi (Mar 17, 2015)

INDICATIONS                                                                     
Severe lifestyle limiting right calf claudication and known peripheral vascular 
disease.                                                                        

PROCEDURES                                                                      
Diagnostic abdominal aortogram.                                                 
Bilateral lower extremity digital subtraction angiography with run off.         
Interventional procedure with right superficial femoral artery angioplasty from 
the left common femoral artery access, retrograde approach, crossover technique.

DESCRIPTION OF PROCEDURE                                                        
After obtaining informed consent from the patient, a five French sheath was     
placed into the left common femoral artery under fluoroscopic guidance.  A five 
French Contra catheter was advanced into the abdominal aorta.  Abdominal        
aortography was performed.  The catheter was then withdrawn to the aortic       
bifurcation and aortoiliac angiogram was then performed.  Over a hydrophilic    
wire, the Contra catheter was advanced selectively into the right common        
femoral artery.  Selective right lower extremity angiography with run off was   
then performed.  After identification of the subtotal occlusion of the right    
superficial femoral artery in the previously distended segment, the original    
five French sheath and Contra catheter was then exchanged over a support wire   
for a six French by 45 centimeter destination sheath. The sheath was then       
positioned into the right common femoral artery.  The Magic Torque wire was     
able to be advanced into the distal popliteal, after which a four French Glide  
catheter was utilized in an exchange fashion to exchange the 0.035 Magic Torque 
wire for a 0.014 Journey wire. This wire was advanced into the distal popliteal 
and the Glide catheter was removed.  Angioplasty was then performed with a 100  
millimeters length 3.0 millimeters balloon.  After initial balloon angioplasty, 
the major waisting on this balloon was at the proximal lesion, proximal stented 
segment and just above.  The three millimeters balloon was then exchanged out   
for a five millimeters balloon angioplasty was performed throughout the stented 
segment, after which balloon angioplasty was performed, as well at the proximal 
lesion, just at the origin of the stent.  Finally, a five millimeters cutting   
balloon was utilized to perform cutting balloon angioplasty of the superficial  
femoral artery at the distal edge of the stent and just below.  After           
withdrawal of all of the balloon  and wire, the angiographic result was         
excellent with brisk three vessel run off, no significant residual stenosis     
visible in the stented segment, no inflow or outflow limitations and no visible 
thrombus or dissection.  The sheath was then withdrawn to the left iliac system 
and left lower extremity digital subtraction angiogram with run off was         
performed. The sheath was then removed and hemostasis was obtained with manual  
compression.  No closure device was utilized. The patient had been given 3000   
units of heparin at the initiation of the intervention. There were no           
complications.                                                                  

HEMODYNAMICS                                                                    
The intraaortic pressure was 147/70.                                            

ANGIOGRAPHY                                                                     
Abdominal aortography revealed single patent bilateral renal arteries.  The     
abdominal aorta was patent.  The aortic bifurcation was patent as was the       
common internal and external iliac vessels bilaterally.  Both common femoral    
vessels were patent.  On the right, the superficial femoral artery was widely   
patent in its proximal segment, however, the stent in the mid segment           
previously placed in November 2013, revealed a subtotal occlusion.  There       
appeared to be a subtotal discrete, occluded segment just at the proximal edge  
of the stent, possibly a denovo lesion.  Immediately thereafter, there appeared 
to be patency of the proximal lumen of the stent.  However, this rapidly        
tapered and in the mid and distal segment of the stent was minimally visible.   
Collaterals, however, did backfill and reconstitute the distal superficial      
femoral artery with a patent popliteal and three vessel runoff.  The deep,      
femoral collateral vessel was large, well developed, and appeared to be patent  
without significant disease.  On the left, the common and deep femoral vessels  
were widely patent. The left superficial femoral artery has a known chronic     
occlusion involving its origin at the common femoral bifurcation, however, the  
well developed large, deep femoral collateral vessel reconstitutes the distal   
superficial femoral artery at the adductor canal with a patent popliteal and    
three vessel run off on the left.                                               

Intervention as described above, successful crossing and simple angioplasty to  
involve cutting balloon angioplasty performed of the subtotal occlusion of the  
right mid superficial femoral artery stented segment.                           

SUMMARY AND CONCLUSIONS                                                         
1.  Lifestyle limiting recurrent right calf claudication.                       
2.  Repeat intervention of the stented mid right superficial femoral artery     
segment with possible treatment of a denovo lesion at the most proximal aspect  
of the stented segment, minimal evidence in fact, for a significant in stent    
restenosis with brisk outflow and now patent popliteal and three vessel run off 
on the right.                                                                   
3.  Known unchanged chronic occlusion of the left superficial femoral artery    
with very large, well developed, deep femoral collaterals, patent popliteal and 
three vessel run off.                                                           
4.  Patent aortoiliac inflow vessels bilaterally.                               

RECOMMENDATIONS                                                                 
Aggressive risk factor modification and medical therapy.                        


    attached is the report from physician performed pta fem/pop, abd arotagram and bilateral lower extremity in a cath lab in hospital. i would like to know if 36247 3rd is billable with 75625,75716,37224 as oops billing.
thanks in advance                





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## j.monday7814 (Mar 17, 2015)

no, 36247 or any catheter placement codes are never billable during lower extremity interventions (37220-37235). Also, this was left common femoral to right common femoral so it would only be second order selective (36246) anyway.

There is also documentation for 75774 along with the other codes you selected.


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## bhargavi (Mar 18, 2015)

thank you so much


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