# Renal and Peripheral angiographies need help coding please



## nancy.anselmo@ccrheart.com (Dec 29, 2015)

1. Right common femoral artery access with catheter placement and selective engagement of bilateral renal arteries with supervision and interpretation. 2. Bilateral renal artery stenting.
HISTORY OF PRESENT ILLNESS: The patient is a 68-year-old with a history of resistant hypertension, peripheral artery disease and history of diastolic heart failure as well as renal insufficiency who presents with refractory hypertension. He has been on multiple medical therapies without successful control of his blood pressure. He underwent renal ultrasound which implied an area of stenosis, specifically in the left renal artery by velocities, and he is referred for renal angiography for evaluation of renal artery stenosis as the culprit of his secondary hypertension.
DESCRIPTION OF PROCEDURE: Informed consent was obtained. The patient understood the risks, benefits and alternatives of the procedure and agreed to proceed with the procedure. The patient was taken to the cardiac catheterization laboratory and prepped in the usual sterile fashion. One percent lidocaine was infused subcutaneously to the right common femoral area. A 6-French 11-cm sheath was placed without complication. A diagnostic 5-French IMA catheter was used for selective renal angiography bilaterally with interpretation. At the conclusion of the procedure, an Angio-Seal device was deployed for arterial hemostasis.
FINDINGS: The catheter was placed selectively in the right renal artery and injected which revealed an eccentric 70% proximal stenosis. The catheter was then redirected to the left renal artery and was selectively injected to determine a 70% proximal stenosis.
SUMMARY: Bilateral renal artery stenosis potentially contributing to the patient's resistant hypertension.
Based on the angiography results, it was determined to proceed with stenting of the bilateral renal arteries.
INTERVENTION: Angiomax was used for effective anticoagulation and an IMA guide catheter was used for selective renal engagement. A Runthrough wire was placed to the distal right renal artery of which a 6.5 x 18 Herculink bare-metal stent was then deployed to 8 atmospheres and the proximal aspect was postdilated to 10 atmospheres. There was an excellent angiographic result with TIMI 3 flow and 0% residual stenosis. The catheter was then redirected into the left renal artery and a Runthrough wire was placed to the distal vessel of which a 6 x 18 Herculink bare-metal stent was then deployed to 8 atmospheres with an excellent angiographic result, TIMI 3 flow and 0% residual stenosis. There was complete vascular engorgement of all calyces on selective injection and renal size was determined as normal.
CLINICAL PATHWAY: The patient will be loaded on Plavix and maintained on dual antiplatelet therapy for at least 30 days. Hopefully, this will afford improvement of blood pressure control. We thank you for the opportunity to participate in the care of this fine gentleman.




PERIPHERAL ANGIOGRAPHY 
INDICATION: Left lower extremity intermittent claudication.
PROCEDURE: Right femoral artery access with catheter placement in the descending aorta with bilateral iliofemoral angiography, selective third order placement of catheter in the left SFA with left lower extremity runoff.
HISTORY OF PRESENT ILLNESS: The patient is a 79-year-old with a history of hypertension, dyslipidemia and peripheral artery disease who presents with symptoms concerning for left lower extremity intermittent claudication. Noninvasive testing implied significant stenosis in the left SFA. In light of ongoing symptoms despite ambulatory therapy, he elects to undergo angiography to better characterize the nature of his disease.
PROCEDURE: Informed consent was obtained. The patient understood the risks, benefits and alternatives of the procedure and agreed to proceed with the procedure. The right groin was prepped in the sterile fashion and 2% lidocaine infused subcutaneously until adequate anesthesia was obtained. Right common femoral artery was accessed using modified Seldinger technique of which a 6 French 11 cm sheath was placed. A 5 French Contra catheter was placed in the descending aorta of which bilateral iliofemoral angiography was performed. Next, a J-wire was then used to cross over and deliver the catheter to the proximal aspect of the left SFA. This was then used for left lower extremity runoff. At the conclusion of the procedure, an Angio-Seal device was used for right arteriotomy hemostasis. 
FINDINGS: The abdominal aorta had mild atherosclerosis and was otherwise normal in caliber. The right common iliac had mild atherosclerosis. The right internal and external iliac were normal in caliber with mild atherosclerosis. The left common iliac had mild atherosclerosis, otherwise normal in caliber. The internal and external left iliacs had mild atherosclerosis and otherwise normal in caliber. The left common femoral artery had mild atherosclerosis. The left SFA had 60% sequential stenosis at the takeoff of the profunda. There was mild atherosclerosis within the profunda itself. The distal aspect of the SFA otherwise had only mild disease. The popliteal artery had mild disease. It was normal in caliber. There was 3-vessel runoff. Mild disease was seen distally.
SUMMARY: Moderate left SFA stenosis at the takeoff of the profunda, mild atherosclerosis in the distal abdominal aorta and iliac tree with 3-vessel runoff in left lower extremity with mild to moderate distal disease.
CLINICAL PATHWAY: At this point, the degree of stenosis does not fully explain the degree of symptomatology. Will focus on medical therapy with further ambulation and risk factor modification. We thank you for the opportunity to participate in the care of this fine gentleman.

Any help please code these maybe 2 times a year Thank you Nancy


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## nancy.anselmo@ccrheart.com (Dec 29, 2015)

For the 1st case I have 36252
                                  37205 These last 2 codes are deleted so I am really confused
                                  75960
Thanks Nancy


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## nancy.anselmo@ccrheart.com (Dec 30, 2015)

I really am having a hard time with these 2 cases, deleted codes and all 
1st case 36252-26
37238 37239


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## smiller (Dec 31, 2015)

*Renal and Peripheral angiographies*

Hi Nancy - Case #1 looks like 37236-RT (renal stent), 37237-LT (add'l renal stent) and 36252-51 (bilateral selective renal angiography)    Case #2 is  36247 (contralateral selective cath placement to the left sfa), 75716-26 (bilateral lower extremity study) and 75625-26 (abdominal angio-you may not be able to bill this because it's considered inclusive of the selective renal angio).                

I hope this helps &#55357;&#56842;


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