# Renal stent



## shescka (Apr 30, 2015)

Hello 
Can I code this with 37236 alone?? is it the rght code?

thank you experts 


PROCEDURE PERFORMED:

Left renal artery stenting with a 7.0 x 15 mm Express SD stent.



PROCEDURE INDICATION:

Worsened chronic renal insufficiency.



BRIEF HISTORY:

This is a 74-year-old male with worsening renal insufficiency for

which the patient has been on dialysis for the last 6 weeks who was

found to have in- stent restenosis and bilateral renal artery stents

on angiogram 2 days ago, is now referred for elective renal

angioplasty.



DESCRIPTION OF PROCEDURE:

After informed consent was obtained, both groins were prepped and

draped in a sterile fashion and under moderate sedation. local anesthesia with 2% lidocaine .

A 6-French

sheath was placed in the right femoral artery and angiogram confirmed

normal sheath positioning, after which a 6-French sheath LIMA guide

catheter was used to engage the left renal artery over a 5-French

multipurpose catheter through which a short BMW wire was passed into

the left renal artery. The in-stent stenosis in the left renal artery

was ballooned with a 2.5 x 12 mm NC balloon after which a 4.0 x 12 mm

NC balloon was used to pre-dilate the lesion followed by a 4.5 x 12 mm

NC balloon. We then successfully deployed a 7 x 15 mm Express SD renal

stent in the left renal artery to 8 atmospheres and then ballooned the

ostium near the abdominal aorta, to 10 atmospheres. This gave a

favorable angiographic result with good stent apposition and no

evidence of dissection. The in- stent stenosis of 90 percent prior to

the angioplasty was reduced to 0 percent post angioplasty. There were

no complications during the procedure and the patient tolerated the

procedure well. The patient also had a right groin 4-French MS sheath

placed in the right femoral vein for venous access during the

procedure. Both sheaths were secured in place to be removed by manual

compression in the holding room. We were also unsuccessful in engaging

the right renal artery with the 6-French IM guide catheter or with 6-

French JR4 guide catheter, and were unsuccessful in passing a BMW wire

into the right renal artery due to which angioplasty was not performed

in this vessel. Also IV heparin was administered during the procedure

to maintain adequate anticoagulation.



POSTOPERATIVE DIAGNOSIS:

Successful left renal artery stent placement with a 7.5 x 15 mm

Express SD renal stent.



PLAN OF CARE:

1. Monitor renal function.

2. Consider angioplasty to the right renal artery if the renal

   function does not improve.

3. Continue dual antiplatelet therapy.


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## jwiles66 (Apr 30, 2015)

We code this with 37236 and then with the selective cath code 36251.  Hope this helps.


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## shescka (Apr 30, 2015)

Sorry to bother but why 36251 and not 36245?


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