# IR coding question



## cdc1cori (Mar 15, 2011)

Can someone please help me with coding the following report? I am so lost with these new codes for 2011.    Thanks in advance!

     RESULT:  Procedures performed:
     1. Left lower extremity angiogram.
     2. Left superficial femoral artery/profundofemoral artery
     angioplasty.
     3. Left superficial femoral artery chemical and mechanical
     thrombolyzes and stent placement.
     4. Left popliteal/peroneal artery mechanical thrombolysis.

     History: 46-year-old female with recurrent left lower extremity
     arterial insufficiency ischemic symptoms. Patient has known
     peripheral arterial disease and is status post prior left lower
     extremity arteriogram and stent graft placement and angioplasty
     on 

     Technique: Following a detailed discussion with the patient
     regarding the procedure, risks, benefits, and alternatives,
     informed consent was obtained and placed in the patient's
     medical record. This procedure is performed with conscious
     sedation using IV Versed and fentanyl. These were minister by
     radiology nursing staff personnel. Please refer to their notes
     for full details.

     The patient was placed supine on the angiography table. The
     right groin was prepped and draped in usual sterile fashion.
      The right common femoral artery was visualized under
     ultrasound an image was store for documentation of the access
     site. The skin and subcutaneous tissues were anesthetized
     lidocaine. A scalpel was used to make a small incision at the
     puncture site. Under ultrasound guidance a myocardial was
     placed into the right common femoral artery directed towards
     the abdominal aorta. A microwire was advanced through the
     needle was removed and exchanged for a 4 French micropuncture
     dilator. The wire and inner dilator were removed and exchanged
     for a Bentson wire to advance under fluoroscopic guidance into
     the abdominal aorta. A 4 French sheath was placed.

     A pigtail catheter was advanced into the abdominal aorta just
     above the level of the celiac trunk and abdominal aortogram                                                was                                                                     performed.

     The catheter was then pulled back to just above the aortoiliac
     bifurcation and oblique aortoiliac arteriograms of the pelvis
     were performed.

     The catheter was then draped over the aortoiliac bifurcation
     and an angled Glidewire was advanced into the left common
     iliac, external iliac, common femoral arteries. The catheter
     was removed and exchanged for an angled glide catheter. The
     wire was removed and exchanged for an exchange length Amplatz
     wire.

     An angled glide catheter was advanced to the distal left common
     femoral artery. A left lower extremity arteriogram was
     performed.

     A 6 French, 40 cm long Balkan sheath was exchanged for the 4
     French sheath and advanced under fluoroscopic guidance into the
     left common femoral artery.

     An angled glide catheter and Glidewire were used to select
     across the distal left common femoral artery/proximal
     profundofemoral artery junction. The wire was exchanged for the
     Amplatz wire. Angioplasty was performed with a 4 mm x40
     millimeters angioplasty balloon. A followup arteriogram was
     performed.

     The wire was then pulled back into the left common femoral
     artery. An angled lie catheter and angled Glidewire were used
     to select the left superficial femoral artery across the
     high-grade proximal stenosis. Angioplasty was then performed
     using a 5 mm x 40 mm angioplasty balloon across the left common
     femoral artery/superficial femoral artery stenosis. A followup
     arteriogram was performed.

     A total of 8000 units of heparin, 8 mg of TPA thrombolytic, and
     AngioJet mechanical thrombolyzes were required in conjunction
     with 5 mm x 120mm angioplasty to recanalize the newly
     thrombosed right superficial femoral artery. A followup
     arteriogram was performed.

     Mechanical thrombolyzes was performed in the distal left
     popliteal artery and into the tibioperoneal trunk. This was
     followed by 4 mm balloon angioplasty.

     The distal right lower extremity arteriogram with runoff was
     performed.

     Mechanical thrombolyzes was performed throughout the length of
     the left superficial femoral artery an additional time. A left
     common femoral artery/superficial femoral arteriogram was
     performed.

     Repeat angioplasty and mechanical thrombolyzes was required in
     the left superficial femoral artery and popliteal artery.

     A 5 mm x 30 mm Metronic stent was deployed across the most
     proximal portion of the left superficial femoral artery. 


     A followup arteriogram was performed.

     A completion infrapopliteal left lower extremity arteriogram
     was performed. 

     Once the ACT level reached below 175, the sheath was removed
     and hemostasis was obtained with manual compression. The
     patient tolerated the procedure well and left the department in
     baseline condition.


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## Jim Pawloski (Mar 15, 2011)

cdc1cori said:


> Can someone please help me with coding the following report? I am so lost with these new codes for 2011.    Thanks in advance!
> 
> RESULT:  Procedures performed:
> 1. Left lower extremity angiogram.
> ...



You had to have fun with this one!
75625 - Abd. Aortogram
75710 - Lt leg angiogram
37184 - Thrombolysis (mechanical)
37226 - Stent in fem-pop. (includes PTA) (Zone 2)
37232- PTA Tibioperoneal Trunk (Zone 3)
Catheter position is bundled into stent procedure.

HTH,
Jim Pawloski, CIRCC


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## cdc1cori (Mar 15, 2011)

Bless your heart!! I have just one more question, Do you just code for one of the mechanical thrombolysis?  It was performed in the femoral AND popitieal/tibioperoneal arteries. 

Thanks for your help! This is starting to make sense...finally!!


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## Jim Pawloski (Mar 16, 2011)

cdc1cori said:


> Bless your heart!! I have just one more question, Do you just code for one of the mechanical thrombolysis?  It was performed in the femoral AND popitieal/tibioperoneal arteries.
> 
> Thanks for your help! This is starting to make sense...finally!!



You can use 37185 for the tibioperoneal artery, popliteal is considered part of the SFA.

Jim


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## cdc1cori (Mar 16, 2011)

It makes a lot more sense.....Thanks again!


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