# Intravascular Stent Placement



## todd5400 (Nov 24, 2009)

I would appreciate if some one would give me their opinion as to how they would code the following

Catheter was nagivatied into the RCC. DS angiography demonstrates a patulour appearing internal carotid artery s/p endarterectomy wit patch graft. DS angiography performed of intracranial circulation from a common carotid artery injection demonstrates no evidence of aneurysm, AVM or vasospam.
The caths removed and navigated into the LCC artery. DS angiography demonstrates no disease at bifurcation. DS angiography again performed at the intracranial cisulation from a common carotid artery injection demonstrates a 2-3mm PCOM infundibulum with a small atretic PCOM arising from the tip.  There is a 6mm cavernous carotid aneurysm projecting
medially.
Once this was accomplished additional control line were performed. There was stasis of flow noted in the common carotid artery. Dissection was discovered in the Common carotid artery. Using mapping technique exchange catherization was performed for 6-French shuttle which was placed in the common carotid artery on the left side. Given the length of dissection a 7 X 30 stent was deployed to cover the leading edge of the dissection. This returned this portion of vessel to its normal caliver however there was marked diminution in the distal portion of the common carotid artery. A second stent was placed to over lap just the end of the first stent. Control angiograpy performed through the intracranial circulation demonstrates no evidence of embolic phenomenon. 

I was thinking

ICD-9  437.3 and 443.21

CPT-4 37215, 36216-59, 75665-26, 75676-26

Thanks


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## Jim Pawloski (Nov 25, 2009)

todd5400 said:


> I would appreciate if some one would give me their opinion as to how they would code the following
> 
> Catheter was nagivatied into the RCC. DS angiography demonstrates a patulour appearing internal carotid artery s/p endarterectomy wit patch graft. DS angiography performed of intracranial circulation from a common carotid artery injection demonstrates no evidence of aneurysm, AVM or vasospam.
> The caths removed and navigated into the LCC artery. DS angiography demonstrates no disease at bifurcation. DS angiography again performed at the intracranial cisulation from a common carotid artery injection demonstrates a 2-3mm PCOM infundibulum with a small atretic PCOM arising from the tip.  There is a 6mm cavernous carotid aneurysm projecting
> ...



I agree with you except for 37215.  There is no report of a distal embolic device used, which you need with 37215.  You need to use 37216 - carotid stent w/o distal embolic protection.  I hope this is not a Medicare case, because Medicare does not pay for 37216.

HTH,
Jim Pawloski


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## todd5400 (Nov 30, 2009)

Thank you for your help Jim.

Mary


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