# Need your help coding please!!



## bevann0402@bellsouth.net (Aug 9, 2014)

I have been looking at this report for the last two days until my eyes have crossed.  Since I have just started coding for this physician (never done cardiology before this), this has been the most detailed, extensive op note and I want to make sure I am understanding.

I will put my answers and questions I have at the end of the op note.  Thanks in advance for your input.  As always it is most appreciated.

indications: abnormal ABI's, abnormal CTA, lifestyle limiting claudication

Procedures performed:
1. 6 French sheath placement in the right common femoral artery w/o difficulty
2. distal aortogram with bilateral lower extremity runoff
3. selective angiography of left iliac artery
4. selective angiography of left common femoral artery
5. selective angiography of left superficial femoral artery
6. selective angiography of left popliteal artery
7. selective angiography of left anterior tibial artery
8. selective angiography of left posterior tibial artery
9. selective angiography of the *PT trunk*
10. selective angiography of the right common femoral artery
11. atherectomy to the mid distal left superficial femoral artery utilizinf TurboHawk LS-C technology
12. percutaneous transluminal angioplasty of the distal left superficial femoral artery at the site of the Hunter canal post atherectomy
13 atherectomy to the proximal PT trunk utilizing TurboHawk sS-C technology
14. atherectomy to the left posterior tibial artery utilizing TurboHawk SS-C technology

complications: all procedures, none

the details of lower extremity angiography and angioplasty were explained to the patient in great detail including the risk factors. patient prepped and underwent 6 French sheath placement in right common femoral artery w/o difficulty. a 6 French pigtail was placed into the distal aorta and distal aortogram with runoff was performed.  distal aorta showing some mild tapering, but no stenosis, no evidence of dissection.

right common iliac artery widely patent
right external iliac artery widely patent
right internal iliac artery widely patent
left common iliac artery widely patent
left external iliac artery widely patent
left internal iliac artery widely patent

runoff to the right foot demonstrating severe 70% lesion to the right superficial femoral artery and the infrapopliteal trunk.

imaging detecting severe lesion to the distal left superficial femoral artery at the site of Hunter canal, severe lesion of the* TP trunk*, and severe lesion of the distal PT.

decision was made to perform angioplasty to the left leg since we had a right groin stick. agniomax was started, we replaced the 6 French sheath catheter with a 7 French Terumo sheath. imaging was performed utilizing TrailBlazer catheter. once imaging was complete, the left leg SFA was wired in its entirety utilizing a Prowater wire. next, we took down an eV3 turbohawk LS-C device and placed it into the distal SFA at the site of the Hunter canal. five passes were performed. the 70% lesion reduced to less than 10%. mild irregularities noted. we took a 5x40 eV3 evercross balloon, deployed it across atherectomy area for 3 minutes. angiography with and without wire in place showing the 70% lesion reduced to less than 10%. next we removed this from the body and we used a Prowater coronary wire to wire the *PT trunk*, which had a severe 80% to 90% lesion. atherectomy was performed utilizing Turbohawk SS-C technology. several passes with final angiography with and without wire in place. severe lesion of 70% to 80% reduced to less than 10%. next we turned our attention and wired the posterior tibial artery utilizing a prowater wire, and again using Turbohawk SS-C technology, severe lesion results in less than 10% to 20% restenosis noted.

at the close of the case, right common femoral artery angiography is performed, demonstrating a widely patent vessel. decision was made to sew sheath into place. patient transferred from the lab and recommendation to proceed with a right lower extremity angioplasty at a later date once the kidneys have recovered. 

1. the two abbreviations used: 
       TP-I found this one-stands for tibioperoneal trunk (I think)
       PT (not sure, lol) still learning all the parts!!

2. I picked cpt codes: 37227,37229
I get confused on the aortograms: don't know if I need 75630 or if I use 75625 and 75716

Am I on the right track, missing a code, etc?  

Thanks again!!

Beverly, CPC


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## Jim Pawloski (Aug 10, 2014)

bevann0402@bellsouth.net said:


> I have been looking at this report for the last two days until my eyes have crossed.  Since I have just started coding for this physician (never done cardiology before this), this has been the most detailed, extensive op note and I want to make sure I am understanding.
> 
> I will put my answers and questions I have at the end of the op note.  Thanks in advance for your input.  As always it is most appreciated.
> 
> ...



Hi Beverly,
You didn't do too bad, but over billed.  
I would code it this way;
75710 - Lt Lower Extremity Angio.  Cannot code for aortogram because there is not mention of the renal arteries.  The "distal aortogram" is just the start of the extremity angio.
37225 - Atherectomy of fem-pop region w/ angioplasty.  No mention of a stent in the SFA.
37229 - Atherectomy of the Tibioperoneal trunk and lt posterior tibial artery.  Again, no mention of a stent, and consider the tibioperoneal trunk as part of one of the three vessels below the knee.

HTH,
Jim Pawloski, CIRCC


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## bevann0402@bellsouth.net (Aug 10, 2014)

Thanks so much.  I would say this is starting to make some sense, but that might be stretching it a bit!! lol

I agree over coded, I spent so much time on this Friday and Saturday that I actually confused myself more than I helped.

Now, with clearer eyes and head, I have reread the report and found where I thought it was a 37227.

Now if I can just get a handle the aortograms...lol

thanks so much!!  
Beverly, CPC


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## kraftycoder@outlook.com (Apr 14, 2016)

*Aortograms simplified*

I realize this reply is late for the original poster, but it may prove helpful to someone else. 

Per Dr. Z:

Use 75630 when run-offs are performed from a single catheter position within the aorta (or the documentation doesn't support separate complete studies from two catheter positions.

75630 requires imaging of the abdominal aorta, not just the distal most aspect of the aorta. The distal most portion of the aorta is incidentally and routinely seen when a pigtail catheter is injected a the level of the aortic bifurcation for the purpose of bilateral lower extremity angiography and is part of code 75716.

Use 75625 and 75716 if a full and complete aortogram and a separate bilateral run-off study are performed from high and low catheter positions in the aorta. (This is often documented with something like, catheter placed at the level of the renal arteries and then moved to the level of the aortic bifurcation.....   This shows 2 catheter placement locations, the aortogram would have been performed at the level of the renal arteries and the run-off performed at the level of the aortic bifurcation (into the common iliac arteries)). Use 75625 and 75610 for the same scenario with a unilateral run-off study.

If revascularization was performed in the same setting, you may not bill for any of the diagnostic testing that covers the same territory as that which was treated. You may bill the S&I for angiography of areas outside of the target area for the revascularization. (i.e. B/L run-off performed, followed by revascularization of the left popliteal. You may bill 75710 for the unilateral S&I of the right leg. All diagnostic testing performed on the left side is included in the revascularization.)

Hope this proves helpful to someone.


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## Kelly_Mayumi (Apr 15, 2016)

kmarshall@hcpnv.com, where did you find this information from Dr Z, because it is indeed helpful!


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