# Femoral angiogram



## OPENSHAW (Mar 26, 2014)

Pre-Procedure Diagnosis: PAD, claudication
Post-Procedure Diagnosis: PAD, claudication

Procedure performed:  

2-Right femoral angiogram
3. Left lower extremity bolus chase 
4. PTA and atherectomy of left SFA artery

Indications:
1.Claudication (lifestyle limiting)

Anesthesia Used: IV versed and fentanyl, local 2% lidocaine

Blood Loss: 15 mL
Condition: stable
IV Contrast Used:  200 mL
Complications: none

Procedure and Findings in Detail: The procedure was described to the patient including benefits, risks, and alternatives to the procedure.  The patient confirmed understanding.  The patient signed the informed consent.  He was brought into the cath lab.  The bilateral groins were prepped in a sterile fashion, and a sterile drape was placed over the patient.

The right common femoral artery (CFA) was palpated and the region above the artery was anesthetized with 2% local lidocaine.  A Cook needle was used to access the right CFA.  The wire was visualized under fluoroscopy ascending into the common iliac artery.  A 7 French sheath was placed over the wire without difficulty in the normal form and fashion.
Fist, right common femoral angiogram is done. This revealed 40-50% calcific common and external iliac stenoses
Pullback gradient was <5 mmHg

 5 Fr Lima  diagnostic catheter and guided by the wire proximal to the iliac bifurcation.  The J wire was pulled back into the catheter. The wire was advanced to the left proximal femoral artery.  The catheter was then advanced to the external iliac artery, and the wire removed.  The catheter was aspirated and flushed with normal saline.  A left lower extremity run-off was performed and revealed 90% calcific left SFA stenosis.

The 7 French sheath exchanged over the wire to a 7F Ansel/ sheath without any problem. 
This lesion is crossed with Glidewire and this is exchanged to Viper wire over a support catheter.
CSI atherectomy with 4 runs with 1.5 Crown is performed.Lesion is dilated with 5x100 and 6x40 Sterling balloons with no complication.There was 10% residual stenosis.Then the the balloon was removed. Repeat angiogram revealed <10% residual with good flow. The 7 F sheath was exchaged to a short 7F sheath.  

The patient was in hemodynamically stable condition throughout entirety of the procedure.  The sheath will be removed in Telemetry when ACT is less tham 130/min and manual pressure will held for 20 min.  A 5 lb sandbag was placed over the groin of entry for 4 hours, and the patient will be on bed rest for the duration.  

Aggressive medical management for CAD and associated risk factors will continue and there are medication changes consisting of the following: Plavix.  The patient has been encourage to start a walking regimen.  Patient will follow-up with me on April 10, 2014.

IMPRESSION:
1.PAD

PLAN/RECOMMENDATION:

1.Successful atherectomy +PTA to left SFA
2. Right SFA will be addressed in the next session through antegrade approach.

Would this be codes as:
36225
75716-59-26
Diagnosis:  443.9 PVD


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## dpeoples (Mar 27, 2014)

OPENSHAW said:


> Pre-Procedure Diagnosis: PAD, claudication
> Post-Procedure Diagnosis: PAD, claudication
> 
> Procedure performed:
> ...




Your cpt code selection looks correct to me. However, by definition, an atherectomy removes atherosclerotic plaque, so I would use 440.21 for the ICD 9 code.

HTH


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## theresa.dix@tennova.com (Apr 1, 2014)

dpeoples said:


> Your cpt code selection looks correct to me. However, by definition, an atherectomy removes atherosclerotic plaque, so I would use 440.21 for the ICD 9 code.
> 
> HTH



I think on this one you would want to use 37225 cpt.


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## dpeoples (Apr 2, 2014)

theresa.dix@ethc.com said:


> I think on this one you would want to use 37225 cpt.



good catch Theresa


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## theresa.dix@tennova.com (Apr 3, 2014)

dpeoples said:


> good catch Theresa




Thanks Danny.


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