# I need help in coding pls.... Peripheral Angiography



## Goyard71 (Jul 22, 2013)

The patient was brought to the catheterization lab and prepped and draped in a 
  sterile fashion. Lidocaine was placed to the left common femoral area. A 6
  French sheath was placed to the left common femoral artery using Seldinguer
  technique. Next angiography of the groin site and down the left leg was
  performed. Next a LIMA catheter was used over a Glidewire to be placed to the
  right common femoral artery. Angiography down the right leg was performed.

  At this point Glidewire was replaced into the mid SFA. Lima Catheter was re-
  moved. The short sheath was removed, and a 6-French Ansel sheath was
  placed to the level of the right common femoral artery. Glidewire was used to 
  cross over the distal SFA lesion, and then a Glide catheter was placed distally.
  Glidewire was removed. Angiography of the infrapopliteal vessels to confirm
  intraluminal placement as well as distal flow was performed via the Glide ca-
  theter, which was placed at the level of the popliteal artery.

  The atherectomy Viper wire was placed into the anterior tibial artery. The Glide
  catheter was removed. The atherectomy device was prepped in a standard
  fashion and placed at the level of the distal SFA. Multiple runs were performed 
  at 60, then followed by a polishing run at 90. Catheter was removed. Angio-
  graphy was performed.

  At this point dilatation was performed with a 5.0 X 80 Fox plus balloon to 12 
  atmosphere. The balloon was removed. There was still greater than 30% 
  residual stenosis and haziness of the heavily calcified segment. Thus, stenting
  was performed with a 6.0 X 100 Absolute Pro stent used 5.0 post dialtion up to
  16 atmospheres. Next angiography was performed,showing good flow through-
  out the entire SFA, less than 10% residual stenosis of the stented segment, and
  continued 3 vessel runoff in the foot. Wire was removed. Ansel sheath was
  brought to the left externel iliac. Then Angio-Seal was deployed. The procedure
  was performed under heparin.

  The patient tolerated the procedure well and remains hemodynamically stable.
  There was good groin hemostasis and no evidence of oozing, bruising or 
  hematoma.

  Impression:
  1) Bilateral iliac arteries are widely patent.
  2) In the right system, the external iliac and common femoral artery are widely
      patent. The SFA is widely patent until it gets to the distal segment at 
      approximately the level of the Hunter's canal, where there is 80% heavily
      calcified disease. Status post atherectomy and PTA revealed greater than
      30% residual stenosis and some haziness concerning for dissection.Thus,
      stenting was performed with a 6 X 100 Absolute Pro stent and post dilation
      now revealing less than 10% residual stenosis and aggressive normal flow 
      through the vessel. In the popliteal and infrapopliteal segments, these were
      all widely patent with 3-vessel runoff.
  3) On the left system, the left common femoral artery, SFA, popliteal and the
      initial portion of the infrapopliteal vessels are all widely patent and correlate 
      with a normal ultrasound of the left system.

 Post Procedure: The patient tolerated the procedure well, remains hemodyna-
  mically stable and is asymptomatic. The patient has significantly improved  flow
  We will need to closely follow on medical therapy. We will institute Plavix at this
  time.

  Thank you very much in advance.


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## Jim Pawloski (Jul 22, 2013)

Goyard71 said:


> The patient was brought to the catheterization lab and prepped and draped in a
> sterile fashion. Lidocaine was placed to the left common femoral area. A 6
> French sheath was placed to the left common femoral artery using Seldinguer
> technique. Next angiography of the groin site and down the left leg was
> ...



You have 75716, 37227-rt
HTH,
Jim Pawloski, CIRCC


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## Goyard71 (Jul 23, 2013)

Thank you very much, Mr. Pawloski. I really appreciate your help.
I am new at coding peripheral angiography and it's been really quite a challenge. Can you please give me  some tips how to clearly understand coding peripheral angiography  procedures. I have been reading   the guidelines but it  is still confusing me. Maybe there is an easier way to understand it.

Thank you once again.


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