# RT SFA Stent +



## amym (Jul 8, 2013)

I am having a hard time coding the selective carotid angio.  Please help.  I am playing a guessing game here.  I have: 37226, 36216, 75625-26-59, 75710-26-59????

Procedure: RT lower extremity angiogram with runoffs and PTA balloon angioplasty and stenting of the RT SFA.  Left SFA Stent Performed on 5/17.
PROCEDURE: The patient was brought to the angiographic suite and the patient's left groin was prepped and access was obtained via 5-french sheath.  A 5 French JR4 cathetere was advanced initially first to the right brachiocephalic artery and cephalic artery and at the level selective right carotid angiogram was done and oblique views and lateral views were also obtained which revealed nonobstructive carotid artery disease.  After that, the JR4 catheter was taken back and advanced into the left common carotid artery and from that level, selective shots of internal/external carotid artery were taken and bothe lateral and oblique views were taken and this showed 30-40% stenosis of the left common carotid artery.  After that JR catheter was withdrawn down into the abdominal aorta and the right renal artery was laterally engaged.  The right renal artery showed no obstructive sclerotic disease.  On the contralateral side, the left renal artery did show about 30% of non-obstructive lateral sclerotic disease in the proximal portion of the renal artery.  After that, JR catheter was taken out and 5-Frnech Omni flush catheter was advanced over a wire and crossed over to the contralateral side in an up-and-over fashion.  After the catheter was passed to the right common femoral artery and the Glidewire was withdrawn.  The Glidewire was replaced with 0.35 Sepracor wire which was brought distally in the right popliteal artery and the rest of the procedure was carried out on this wire.  The 5-french system was changed for a 7-french system and 45 cm cheath was placed.  The patient's diagnostic shots revealed moderately severe diffuse ___ left superficial artery and distal to the stent there was further diffuse severe disease in the left superficial femoral artery.  Gradients were measured across the proximal region of the SFA which relvealed a gradient of 100 mmHg.  At this point, it was decided to intervene, where initially a 5-0 and then 20 balloon were used and ____ for the distal SFA ___ segment, which revealed ___ of the distal SFA and suboptimal in the stent portion of the proximal SFA.  After that, there were 3 stents, ___ stent and were pulse dilated with a 5-0 and then 20 balloon with good angiographic results.  After that, further Angiostar cutting balloon was used with good angiographic results.  After this, the balloon and the wires were withdrawn, distal vessel angiography runoff was performed with included 1-vesse; tp 2-vesse; rimppf.  Physical examination of patient's dorsalis pedis pulse, which was on Doppler improved 2+.  The patient's long sheath was exchanged for the short 8-French sheath and the patient was taken to the holding area.


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## Jim Pawloski (Jul 8, 2013)

amym said:


> I am having a hard time coding the selective carotid angio.  Please help.  I am playing a guessing game here.  I have: 37226, 36216, 75625-26-59, 75710-26-59????
> 
> Procedure: RT lower extremity angiogram with runoffs and PTA balloon angioplasty and stenting of the RT SFA.  Left SFA Stent Performed on 5/17.
> PROCEDURE: The patient was brought to the angiographic suite and the patient's left groin was prepped and access was obtained via 5-french sheath.  A 5 French JR4 cathetere was advanced initially first to the right brachiocephalic artery and cephalic artery and at the level selective right carotid angiogram was done and oblique views and lateral views were also obtained which revealed nonobstructive carotid artery disease.  After that, the JR4 catheter was taken back and advanced into the left common carotid artery and from that level, selective shots of internal/external carotid artery were taken and bothe lateral and oblique views were taken and this showed 30-40% stenosis of the left common carotid artery.  After that JR catheter was withdrawn down into the abdominal aorta and the right renal artery was laterally engaged.  The right renal artery showed no obstructive sclerotic disease.  On the contralateral side, the left renal artery did show about 30% of non-obstructive lateral sclerotic disease in the proximal portion of the renal artery.  After that, JR catheter was taken out and 5-Frnech Omni flush catheter was advanced over a wire and crossed over to the contralateral side in an up-and-over fashion.  After the catheter was passed to the right common femoral artery and the Glidewire was withdrawn.  The Glidewire was replaced with 0.35 Sepracor wire which was brought distally in the right popliteal artery and the rest of the procedure was carried out on this wire.  The 5-french system was changed for a 7-french system and 45 cm cheath was placed.  The patient's diagnostic shots revealed moderately severe diffuse ___ left superficial artery and distal to the stent there was further diffuse severe disease in the left superficial femoral artery.  Gradients were measured across the proximal region of the SFA which relvealed a gradient of 100 mmHg.  At this point, it was decided to intervene, where initially a 5-0 and then 20 balloon were used and ____ for the distal SFA ___ segment, which revealed ___ of the distal SFA and suboptimal in the stent portion of the proximal SFA.  After that, there were 3 stents, ___ stent and were pulse dilated with a 5-0 and then 20 balloon with good angiographic results.  After that, further Angiostar cutting balloon was used with good angiographic results.  After this, the balloon and the wires were withdrawn, distal vessel angiography runoff was performed with included 1-vesse; tp 2-vesse; rimppf.  Physical examination of patient's dorsalis pedis pulse, which was on Doppler improved 2+.  The patient's long sheath was exchanged for the short 8-French sheath and the patient was taken to the holding area.



I would code this exam this way
36222-RT, 36222-LT, 36252, 37224.
The renals were selected which deletes the abdominal aorta.
No documentation of a unilateral extremity arteriogram, just the intervention.
HTH,
Jim Pawloski, CIRCC


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## amym (Jul 9, 2013)

Thanks for clearing that up.  I was way off!  You wouldn't bill 37226 for the stent?


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## Jim Pawloski (Jul 10, 2013)

amym said:


> Thanks for clearing that up.  I was way off!  You wouldn't bill 37226 for the stent?



I missed the stent placement, so yes bill the stent, not the PTA.
Thanks,
Jim Pawloski, CIRCC


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## deeva456 (Jul 11, 2013)

I have a question...why would you not code 75710-26 59 on this case? is it not supported?

The Glidewire was replaced with 0.35 Sepracor wire which was brought distally in the right popliteal artery and the rest of the procedure was carried out on this wire. The 5-french system was changed for a 7-french system and 45 cm cheath was placed. The patient's diagnostic shots revealed moderately severe diffuse ___ left superficial artery and distal to the stent there was further diffuse severe disease in the left superficial femoral artery. Gradients were measured across the proximal region of the SFA which relvealed a gradient of 100 mmHg. At this point, it was decided to intervene, where initially a 5-0 and then 20 balloon were used and ____ for the distal SFA ___ segment

Thank you,
Dee


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