# Revascularization fem/pop area with atherectomy



## kmuerth (Jun 24, 2013)

Please read and see my codes and questions at the end! Thanks! 

PROCEDURES:  
ABDOMINAL AORTIC ANGIOGRAPHY 
SELECTIVE ANGIOGRAPHY OF THE LEFT COMMON FEMORAL ARTERY
SELECTIVE ANGIOGRAPHY OF THE LEFT POPLITEAL ARTERY WITH RUNOFF TO THE LEFT LEG
SELECTIVE ANGIOGRAPHY OF THE RIGHT COMMON FEMORAL ARTERY WITH RUNOFF TO THE RIGHT LOWER EXTREMITY 
FOX HOLLOW ATHERECTOMY OF THE MID LEFT SUPERFICIAL FEMORAL ARTERY
PTA OF THE MID LEFT SUPERFICIAL FEMORAL ARTERY

PROCEDURE:    
Informed consent was obtained from the patient.  The patient was prepped and draped in the usual fashion.  1% Lidocaine solution was injected in the right groin for local anesthesia.  IV sedation was performed using Versed and Fentanyl.  .  A 6 French sheath was inserted into the body of the right common femoral artery using a modified Seldinger technique with no complications.  Abdominal aortic angiography was performed using a 6 French straight pigtail catheter.  Selective angiography of the left common femoral was performed using a 6 French IM catheter.  Selective angiography of the left popliteal artery was performed using the inner lumen of a 5 x 60 mm balloon.  Selective angiography of the right common femoral artery with runoff to the right lower extremity was performed using the 6 French 10 cm sheath.  The results were as follows.  

RESULTS: 
Hemodynamics:  
Aortic opening pressure was 172/74 with a mean pressure of 115.  Aortic closing pressure was 117/78 with a mean pressure of 96.  

Angiography: 
The abdominal aorta was a small to medium caliber vessel with moderate ectasia distally but no focal stenosis.  There were single renal arteries to each kidney bilaterally with no significant disease noted.  The left common iliac artery was a small to medium caliber vessel with 40-50% sequential stenoses.  The left internal iliac artery was a medium caliber vessel that was patent.  The left external iliac artery was a medium caliber vessel that was widely patent.  The left common femoral artery was a small to medium caliber vessel that was widely patent.  The left superficial femoral artery was a small to medium caliber vessel that was totally occluded  within the mid segment.  The left popliteal artery was a medium caliber vessel that was widely patent.  The left anterior tibial artery was totally occluded  in the proximal to mid segment.  The left tibial peroneal trunk was a medium caliber vessel that was widely patent.  The left peroneal and left posterior tibial arteries were both medium caliber vessels that were widely patent.  There appeared to be two-vessel runoff to the left lower extremity.  

The right common iliac artery was a medium caliber vessel with mild luminal irregularities.  The right internal iliac artery was a medium caliber vessel that appeared to be patent.  The right external iliac artery appeared to be widely patent.  The right common femoral artery was a medium caliber vessel with mild luminal irregularities.  The right profundal femoris artery was a medium caliber vessel that was widely patent.  The right superficial femoral artery was a medium caliber vessel with 20% distal stenosis.  The right popliteal artery was a medium caliber vessel that was widely patent.  There appeared to be three-vessel runoff to the right lower extremity.  After reviewing the diagnostic images, a decision was made to proceed with percutaneous coronary intervention of the mid left SFA.  The patient was anticoagulated with 5000 units of IV heparin.  An Amplatz super stiff wire was placed through the 6 French IM catheter.  The 6 French IM catheter was removed.  The 6 French 10 cm sheath was exchanged out for a 7 French 45 cm sheath.  The total occlusion was crossed using a 4 French Terumo glide catheter, and a straight stiff glidewire.  Subsequent to this, the straight stiff glidewire was exchanged out for a 300 cm BMW wire.  The glide catheter was also removed.  The patient underwent Fox Hollow atherectomy using a Silver Hawk LX-M atherectomy device with multiple passes performed followed by balloon angioplasty using a 5.0 x 60 mm Fox Plus balloon at 4 atmospheres.  This resulted in a reduction from 100% to less than 10% original stenosis with TIMI III flow; no complications.  There continued to be two-vessel runoff to the left lower extremity.  Following the intervention all wires and catheters were removed.  


IMPRESSIONS:  
No hemodynamically significant inflow disease involving the lower extremities bilaterally. 
Widely patent renal arteries bilaterally.  
Widely patent right superficial femoral artery with three-vessel runoff to the right lower extremity.  
Total occlusion of the mid left superficial femoral artery with two-vessel runoff to the left lower extremity including a totally occluded  left anterior tibial artery.
Successful Fox Hollow atherectomy of the mid left superficial femoral artery followed by PTA using a Fox Plus Balloon resulting in reduction from 100% to less than 10% original stenosis.  
Evidence of residual 40-50% stenosis involving the mid left superficial femoral artery more than 5 cm proximal to the total occlusion.  


I get that it should be 37225-LT for the unilateral left fem/pop pta and atherectomy, and that this includes all the angiography and sselective catherizations on the left side. 

I think I am to code the 75710-59RT for the Runoff from the rt common fem artery down.

Not sure what to do about the abdominal aortagram but I think I should code 75625??? for it was kind of a stand alone procedure?? Im thinking this way because there is a gap between that procedure and any start of selective cath w injections done on the right and left side.  Let me know!


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