# Cpt 37227-Can I bill anything



## amym (Jul 5, 2011)

Can I bill anything else other than 37227?

PROCEDURE PERFORMED: 
1. Antegrade arterial stick to the left common femoral artery. 
2. Laser atherectomy followed by balloon percutaneous transluminal 
angioplasty to the distal superficial femoral artery/popliteal artery 
chronic total occlusion. 
3. Percutaneous transluminal angioplasty to mid superficial femoral 
artery. 
4. Placement of stent to the common femoral artery at the level of the 
groin with IDEV stent. 

INDICATION:  The patient is presenting with gangrene to the left fifth 
toe and also severe ischemic changes of the left foot.  Finding of 
severe occlusive disease with total occlusion of the superficial femoral 
artery in the distal third and going into the popliteal and high grade 
stenosis in the mid superficial femoral artery and high grade stenosis 
of the common femoral artery with significantly reduced inflow and 
revascularization is recommended. 

PROTOCOL:  After the patient was identified, the patient was brought to 
the endovascular lab.  This is a very lengthy and long procedure and 
required multiple levels of procedural sedation.  At this point first an 
antegrade 7 French stick was performed to the left common femoral artery 
and then subsequently guidewire was advanced into the superficial 
femoral artery.  At this point a Storq catheter was used to exchange the 
wire.  After the Storq wire was advanced and crossed the lesion distally 
in the lower third and then at this point was exchanged with an 0.014 
wire upon which a 2.0 laser fiber was advanced and multiple passes were 
made of the chronic occlusion.  Improvement was noted and subsequently 
followed by a 4 x 80 Admiral balloon with excellent results with full 
restoration of flow noted in this segment. 

Attention was directed to the mid superficial femoral artery.  The same 
4 x 80 Admiral balloon was then used to dilate in the mid segment with 
marked improvement and therefore it was felt not to be necessary to 
stent it.  Subsequently, the same balloon was pulled back into the 
common femoral artery in the area of a very complex and calcified high 
grade stenosis of the superficial femoral artery was treated with a 
balloon inflation first.  Subsequently, IDEV 5 x 60 stent was then 
delivered at this area with full coverage with excellent placement. 
Following this a 6 x 40 balloon was used, which post dilate excellent 
end results were noted with marked improvement and the entire flow was 
pictured and excellent three vessel runoff was noted to the foot.


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## Jim Pawloski (Jul 5, 2011)

amym said:


> Can I bill anything else other than 37227?
> 
> PROCEDURE PERFORMED:
> 1. Antegrade arterial stick to the left common femoral artery.
> ...



Since there wasn't an diagnostic angio performed, that is all you can bill.
Thanks,
Jim Pawloski, CIRCC


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