# 37288 and 37232?? Help!



## csorensen21@yahoo.com (Apr 15, 2014)

A little confused on what to exactly bill plus the angiographies. Can someone help out with this one!?

PROCEDURES:  
1.  Selective angiography of the right Common Iliac artery.
2.  Selective angiography of the right popliteal artery.
3.  Successful PTA of the Post tibial artery, which was ( CTO) 100% occluded,
chronic flow down to 20% residual.  
4.  Successful percutaneous intervention of the tibioperoneal trunk, which
was 90%, to 20% residual.

OPERATOR:  


INDICATIONS:  Severe diffuse disease and abnormal ABI of 0.3 with
significant life-limiting claudication.  The patient was consented.  TIME OUT 
performed.  Risks and benefits were discussed according to protocol.  


DESCRIPTION OF PROCEDURE:  The patient was accessed from the left peroneal artery.  A 6-French sheath was advanced and the LIMA  catheter was used to direct the catheter into the left main artery.  Selective angiography was performed.  Then, a glide Edge -wire was direct approached to the anterior Tibial Artery  across the SFA and that was used as a Pinnacle Distenation  45 cm sheath across and was directed into the right SFA.  Subsequently, we used a Trail Blazer catheter to help support wires.  As we were unable to advance the glidewire, we used a Spartacore, but we were unsuccessful crossing the lesion, then was followed by a Pilot 50, which was also unsuccessful.  Finally, we used a Pilot 200, 300 cm, which was successful across the lesion and we used a 2.0 tapered balloon to 2.5.  The length was 21 cm and then we inflated it multiple occasions from the distal segment of the Post tibial artery at the level of ankle up to the popliteal artery with excellent result, abolishing a 90% tibioperoneal trunk lesion and 100% occlusion of the Posterior tibial artery, which was chronically occluded and successful recanalized vessels.  

FINDINGS:  As following:
1.  Right common iliac artery widely patent.
2.  Right common femoral artery widely patent.
3.  Right superficial femoral artery widely patent.
4.  Right popliteal artery patent.
5.  Tibioperoneal trunk 90% stenosis, feeding into a patent anterior
tibial artery and that had sluggish flow secondarily due to the reduced
flow in the tibioperoneal trunk and occluded posterior tibial artery with
reduced flow with diffuse disease in the peroneal artery.
6.  Successful percutaneous intervention of the tibioperoneal trunk and
the posterior tibial artery with balloon angioplasty and improvement in
the flow in the tibioperoneal trunk, improved flow in both peroneal and
the anterior tibial artery with reinstitution of the 3-vessel flow of the
tibioperoneal trunk.


The patient tolerated the procedure well without any other problems and
catheters were removed.  Angio-Seal was deployed to the left femoral
artery.  


The patient will be maintained on the same medications.  We will hold
metformin for 3 days; resume aspirin on Plavix.


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## jkayser (Apr 16, 2014)

Hi, CPT 37228 would be appropriate.  The angioplasty of the tibio-peroneal trunk is not coded separately in this case since angioplasty was also done on the posterior tibial artery.  This is counted as a single initial vessel.  

The selective angiographies are not well documented.  There is no mention of the catheter being selectively placed in the iliac nor the popliteal in the Description of Procedure section.  It only mentions "left main artery" which isn't clear.  The report also doesn't describe the angiographies as diagnostic with a decision to proceed with the angioplasty.  

CPT 37228 includes all radiological supervision and interpretation directly related to the intervention and imaging performed to document completion of the intervention.

I hope this helps.

Jean Kayser CPC CIRCC


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## csorensen21@yahoo.com (Apr 16, 2014)

Thank you Jean! That is what I was confused on. I had a feeling that 37228 was correct and that all the angiographies weren't clear enough to actually additionally code them separate to the initial angio. Thank you for the help it is much appreciated. I should have went with my gut instinct!


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## mrsalexander (Apr 18, 2014)

Jean - I have been asked to help out our hospital IR dept with creating a new order form for procedures. Do you have any suggestions on finding a good form that has the CPT codes on it so the physician offices can get a prior auth? Any help/advice would be greatly apprecitated.
Thanks!


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## jkayser (Apr 18, 2014)

Hi, I wish I could help but I don't work in a hospital setting.  Maybe you could start a new thread to put your request out there.  Someone else may be able to help out with some ideas.

Thanks and good luck!

Jean


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