# Interventional Coding



## amym (Jun 2, 2011)

Still need help with these.  Can't quite understand the difference between different approach.

I have 37226 for the stent but what about the approach?

PROCEDURES PERFORMED: 
1. Antegrade left femoral artery approach. 
2. Stenting followed by percutaneous transluminal angioplasty of the mid 
left superficial femoral artery. 

CLINICAL SUMMARY:  The patient is a 46-year-old female with profound 
claudication affecting her left leg.  She underwent peripheral 
arteriogram on April 1, 2011 and was found to have a left superficial 
femoral artery middle/distal third junction focal stenosis of 80% 
severity.  It was felt that because of the very acute angulation at the 
bifuraction of the aorta, the only viable approach would be an antegrade 
femoral artery access. Therefore, she was scheduled electively for stent 
procedure today. 

PROTOCOL:  The patient was brought to the endovascular lab and both 
groins were prepped and draped in the usual sterile fashion.  Under 
fluoro guidance, the left common femoral artery was marked and access 
was obtained antegrade ________ with passage of wire into the 
superficial femoral artery and then subsequently a dilator was advanced 
to confirm positioning and then subsequently a 6 French 6 x 23 sheath 
was advanced and positioned in the left superficial femoral artery 
selectively. 

At this point, imaging confirmed the lesion and it was felt that a focal 
stent approach was the most appropriate one and a Life stent 6 x 60 was 
placed at the lesion site under fluoro guidance and then deployed 
successfully, covering the two lesions that were close to each other. 
Following which significant narrowing existed and therefore a 7 x 40 
balloon was used to post dilate this lesion to full expansion. 
Excellent results were noted at this point and patient was given Plavix, 
even through she has received heparin.  The sheath was pulled and then 
manual compression was used for hemostasis.  There were good pulses 
present at the end of the procedure.  No complications occurred. 

IMPRESSION: 

FINAL SUCCESSFUL STENTING FOLLOWING PERCUTANEOUS TRANSLUMINAL 
ANGIOPLASTY.  BALLOON INFLATION OF THE MID LEFT SUPERFICIAL FEMORAL 
ARTERY WITH 6 X 60 LIFE STENT, POST DILATED WITH 7 X 40 RIVAL BALLOON 
WITH STENOSIS REDUCTION FROM 80% TO 0%. 

Thanks for your help!


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## Jim Pawloski (Jun 2, 2011)

amym said:


> Still need help with these.  Can't quite understand the difference between different approach.
> 
> I have 37226 for the stent but what about the approach?
> 
> ...



That's all you can bill.  There is a previous arteriogram, so you can't bill for diagnostic imaging.  Since all work was performed from a single access site, all catheter placements and imaging is bundled into the stent placement.
HTH,
Jim Pawloski, R.T.(R)(CV), CIRCC


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