# Correct coding??? Vertebral pta & stent



## slicksurfer (Aug 2, 2010)

TITLE OF PROCEDURE:   
Aortogram, left subclavian chronic total occlusion attempted angioplasty, left vertebral angioplasty and stent.  

BRIEF HISTORY:  This is a 73-year-old male with left subclavian steal syndrome and left arm weakness.  The patient has also had a left vertebral stenosis of 80 percent, referred for angioplasty and stent of both territories.  The patient was explained in detail the risks, benefits, and alternatives to the procedure, and he agreed to proceed.  A witnessed consent was signed and placed on the chart.   

DESCRIPTION OF PROCEDURE:   The patient was brought to the endovascular suite. He was  prepped and draped in the usual sterile fashion.   One percent lidocaine was used to anesthetize the right groin.  There, a 6 French femoral arterial sheath was placed via Seldinger technique, and a pigtail catheter showed the occlusion of the left subclavian with heavy calcification.  The vertebral artery also had an 80 percent diameter stenosis.  The sheath was exchanged for an 8 French sheath.  Heparin was given to maintain the ACT greater than 250, and a 0.035 angled and straight glide wires with a support catheter were used to try to cross the occlusion.  This did not cross due to significant cap rigidity.  This was followed by the use of a Frontrunner catheter and once again did not cross.  Ultimately, it was felt that there was too heavy a calcification, despite multiple attempts with the angled and straight glidewires, and ultimately the vertebral artery was then engaged using a 0.014 BMW wire, and direct stenting was performed with a 3.5 x 15 millimeter Promus drug-eluting stent, deployed at 10 atmospheres for 30 seconds, leaving a 0 percent residual stenosis.  

IMPRESSION:  
1. Status post successful left ostial vertebral angioplasty and stent, 80 percent prelesion stenosis, 0 percent post restenosis, treated with a 3.5 x 15 Promus.   

2. 100 percent left subclavian artery stenosis, unable to be crossed with the angled and straight glidewires and a Frontrunner.  We will try a left arm brachial approach in the future.   

3. No complications.

- We coded 75625 for the aortagram and 0075T for the stent placement.
- Did we code this right?


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## Jim Pawloski (Aug 3, 2010)

slicksurfer said:


> TITLE OF PROCEDURE:
> Aortogram, left subclavian chronic total occlusion attempted angioplasty, left vertebral angioplasty and stent.
> 
> BRIEF HISTORY:  This is a 73-year-old male with left subclavian steal syndrome and left arm weakness.  The patient has also had a left vertebral stenosis of 80 percent, referred for angioplasty and stent of both territories.  The patient was explained in detail the risks, benefits, and alternatives to the procedure, and he agreed to proceed.  A witnessed consent was signed and placed on the chart.
> ...



75650 is for the thoracic arch angiogram, and you are correct on the vertebral stent placement.  However, I have a problem with the report.  This is assuming normal anatomy.  The left vertebral artery is a branch off the lt subclavian artery.  The lt subclavian is occluded, and that is why you have the subclavian steal.  It was attempted to open the occluded portion of the lt subclavian, but then a stent was placed in the lt vertebral.  By what access?  Was there a second access through the arm?  Reason I am asking is there can be a lot more codes then what you are asking for, especially how could they get to the vertebral from an occulded subclavian?  Or was the occlusion after the vertebral?
Sorry to ask a lot of questions, but I could not figure out what was going on.
Thanks,
Jim Pawloski, CIRCC, R.T. (R)(CV)


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## slicksurfer (Aug 5, 2010)

Jim Pawloski said:


> 75650 is for the thoracic arch angiogram, and you are correct on the vertebral stent placement.  However, I have a problem with the report.  This is assuming normal anatomy.  The left vertebral artery is a branch off the lt subclavian artery.  The lt subclavian is occluded, and that is why you have the subclavian steal.  It was attempted to open the occluded portion of the lt subclavian, but then a stent was placed in the lt vertebral.  By what access?  Was there a second access through the arm?  Reason I am asking is there can be a lot more codes then what you are asking for, especially how could they get to the vertebral from an occulded subclavian?  Or was the occlusion after the vertebral?
> Sorry to ask a lot of questions, but I could not figure out what was going on.
> Thanks,
> Jim Pawloski, CIRCC, R.T. (R)(CV)



Thank you for your feedback and I agree with what you said about the occlusion in the subclavian.  It doesn't add up but whats evident still needs to be coded.  

I have one more question for you.  This same physician did a diagnostic study of the left carotid artery and angioplastied it.  No stents were placed due to the heavy calcification and tortuosity.  How would you code this?

There doesn't seem to be a carotid artery angioplasty code, only a stent with or without distal embolic protection codes.  I'm puzzled as to not knowing what to code to use because work was done on the vessel.


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## dinora_36 (Jul 16, 2012)

*vertebral PTA & Stent*

I know i'm late but I'm new in this coding (IRA) and I'm researching everything about....but for me vertebral SAPTA is 35475/75978. 0075T is only for stent placement. Sorry. Thx

Dignora Lopez, CPC


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