# Known Occlusion with Attempted Atherectomy



## Robbin109 (Sep 15, 2012)

Anybody wanna give this a go...

Can I get some help coding this please?

Pre-op Diagnoses:

1. Critical limb ischemia with a nonhealing ulcer on the right foot.
2. Known total occlusion of the right popliteal, right tibioperoneal trunk, occluded right anterior tibial and posterior tibial with a single-vessel runoff via reconstituted right peroneal vessel.

Post-op Diagnoses:

1.Critical limb ischemia with a nonhealing ulcer on the right foot.
2. Known total occlusion of the right popliteal, right tibioperoneal trunk, occluded right anterior tibial and posterior tibial with a single-vessel runoff via reconstituted right peroneal vessel.
3. Unsuccessful attempt to recanalize the chronic total occlusion of the right popliteal artery into the peroneal vessel

Procedures Performed:

1. Right lower extremity angiogram.
2. Attempted recanalization of a chronically occluded popliteal and tibioperoneal trunk.  Multiple devices were used but was unsuccessful.

Procedure Performed:

Following informed consent, the patient was brought to the cardiac catheterization lab.
After she was sedated, we proceeded for the right lower extremity angiogram through the left groin approach for which a mircropuncture technique was used to gain access in the left common femoral artery.

Next, Omni flush catheter was placed into the descending abdominal aorta and was then crossed over to the contralateral  side (the right side) with the help of the Advantage Glide.

Next, 70 cm long Ansel sheath was placed in the right distal SFA, and 35 ml of contrast was injected at 3ml/second which confirmed severe stenosis on the right popliteal artery which became totally occluded with a number of collaterals supplying the peroneal artery.  There was no reconstitution of the right posterior tibial artery.  The right anterior tibial artery was seen to be filling distally.

Next, through the Ansel Sheath, multiple devices were used to recanalize the totally occluded right popliteal artery included the Wildcat, Kittycat, and the Crosser device.

The Crosser device did make some progress in the TP trunk, but still could not go distally into the true lumen.  Next, a Kittycat device was again used and we were able to get into  the ongoing peroneal artery, but no quite enter int to he true lumen.  At this time because of increasing fluro time and the contrast, it was decided to stop the procedure, and considered using a retrograde  approach in the future.


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## AngelaFoster (Dec 20, 2012)

I just came across the same situation. As for the attempted recanalization I'm not sure if this is ok to code. I personally feel like they are going in and using the atherectomy system and should be able to bill for it. I can't find any documentation anywhere though.


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