# Peripheral Help Please



## willnat2 (Oct 21, 2013)

I could really use some help with this procedure, please.

Procedure Performed:
Common Iliac Angiogram-Bilateral
Bilateral Lower Extremity Angio
Renal Angiogram- Bilateral
PTA Right Proximal SFA, Right Femoral, Right External Iliac, and Right Common Iliac Arteries
Thrombectomy Right Peroneal Artery and Right Anterior Tibial Artery
PTA Right Peroneal and Right Anterior Tibal Arteries

INDICATIONS:
Diag Indication: PVD Unspecified 443.9
Disabling Claudicaton of the RT Lower Extremity

PROCEDURE:
After obtaining informed consent, the patient was transferred to the Cardiac Cath Lab in stable condition. The patient was draped and prepped in a sterile fashion. No prior angiograms were done prior to the pt's sx.

The groin was anethetizaed locally using 1% Lidocaine. The Left femoral artery was canulated using a modified Seldinger technique and a 6 French arterial sheath was introduced. A 6 French diagnostic catheter was then advanced to the renal ostium and angiography was performed of the renals, Aorta and Bilateral Iliacs, Femerol, Popliteal, Tibiais, and Peroneal.

A 6 F Crossover sheath was placed into the the R Iliac and a .035 wire was placed into the distal Popliteal A 200mm 6.0 Balloon was used to dilate the Femerol and Iliac arteries. We had a very good result after serial inflations but material embolised distally. This required aspiration catheters of the Tibial perineal trunk and PTCA of the Perineal and Ant. Tibial.

The sheath was removed without difficulty. Pt. tolerated procedure well.

PERIPHERAL FINDINGS:
Lt Renal Discrete 35% lesion
Rt Renal Normal 0% lesion
Lt Renal (Ostial), Discrete 35% lesion
Aorta (Mid), Luminal Irregularities 15% lesion
Collateral flow from Rt Int. Iliac to Rt SFA
Rt Common Femoral (Mid), Discrete 100% lesion
Lt Ext. Iliac (Mid), Discrete 50% lesion
Rt Ext. Iliac (Ostial), Discrete 100% lesion Stent to 100%
Lt Ant. Tibial (Proximal ), Discrete 90% lesion

CONCLUSION:
Successful PTCA with arterial aspiration of the Right Iliac, Femerol, Peroneal and Anterior Tibial Arteries 100% to <10% Iliacs and Fermerol with subtotal occ of the Ant Tibial due to plaque shifting.


36252
75716,O 59
37220 RT
37224 RT
37228 RT
37232 RT
37232 RT
37186

I am not sure if this is correct and need some help please.


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## Jim Pawloski (Oct 21, 2013)

willnat2 said:


> I could really use some help with this procedure, please.
> 
> Procedure Performed:
> Common Iliac Angiogram-Bilateral
> ...



This is the way I would code this case;
75630 - Abd. Aortogram with run-offs.  These is no mention that the renals were selected or any catheter movement from upper to lower aorta.
37220 - PTA of common Iliac
37222 - PTA of external Iliac
37224 - PTA of fem-pop region
37186 - Secondary arterial thrombectomy

Angioplasty of the tibial-peroneal arteries are bundled into the thrombectomy charge, so no 37232 or 37228.
HTH,
Jim Pawloski, R.T.(CV), CIRCC


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## willnat2 (Oct 23, 2013)

Jim,

Thank you so much for your help. I just have a couple of questions. Where could I learn more about peripherals? They really confuse me. Aren't they going to be changing in 2014 also. The other thing is that the renals were done, it says a 6 French diagnostic catheter was then advanced to the renal ostium and angiography was performed of the renals.......
Does there need to be better documentation to be able to charge for this? Or can't I charge for it? Thanks in advace.
Leslie


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## willnat2 (Oct 23, 2013)

Jim,

Thank you so much for your help. I just have a couple of questions. Where could I learn more about peripherals? They really confuse me. Aren't they going to be changing in 2014 also. The other thing is that the renals were done, it says a 6 French diagnostic catheter was then advanced to the renal ostium and angiography was performed of the renals.......
Does there need to be better documentation to be able to charge for this? Or can't I charge for it? Thanks in advance.
Leslie


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## dpeoples (Oct 23, 2013)

willnat2 said:


> Jim,
> 
> Thank you so much for your help. I just have a couple of questions. Where could I learn more about peripherals? They really confuse me. Aren't they going to be changing in 2014 also. The other thing is that the renals were done, it says a 6 French diagnostic catheter was then advanced to the renal ostium and angiography was performed of the renals.......
> Does there need to be better documentation to be able to charge for this? Or can't I charge for it? Thanks in advance.
> Leslie



I am not Jim of course, but...
to the renal ostium or into the renal artery makes all the difference.
As worded, I would not code for renal arterigraphy.

HTH


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## Jim Pawloski (Oct 24, 2013)

dpeoples said:


> I am not Jim of course, but...
> to the renal ostium or into the renal artery makes all the difference.
> As worded, I would not code for renal arterigraphy.
> 
> HTH



Hi Danny,
I just saw this post, so thank you for answering his question.  As to the question of changes in the CPT for lower extremity, there are no changes.  The changes occured in stent placement, non lower extremity or cerviocerebral areas, and embolizations.
Thanks again,
Jim Pawloski, CIRCC


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## willnat2 (Nov 1, 2013)

Thank you so much for your help.

Leslie


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