# periperal help



## aforsythe (Sep 29, 2010)

I am hoping for some help, I haven't coded pheripherals for a while and want to make sure I still have an idea of whats going on.  Thanks for your help in advance, I really appreciate it. 

sheath placed in the right common fem artery.  Subsequent to that, a 5-French scatheter was placed into the left common fem artery, and a selective diagnostic left lower extremity angiography was them performed.  This demonstrated 70% stenosis of the left common fem artery.  There was a pressure gradient across the left common iliac artery which was observed at the beginning of the procedure.  Left SFA contains diffuse calcific disease, however it is patent in the proximal and mid segment. The distal SFA is totally occluded in the short segment which is heavily calcified.  Left profunda femoris artery coontains 60% stenosis.  Left pop artery contains 75 - 80% lesion which is also diffusely diseased.  Left ant tibial artery is a small diffusely diseased vessel with multiplle subtotal occlusions.  Left peroneal artery is patent.  Left posterior tib artery is totally occluded.

At this point the patient was given IV heparin.  A 7-French contalateral sheath was placed into the left common fem artery.  Now an .035 quick cross catheter was positiioned into the left SFA and a selective additonal angio was performed at that location.  Now we were avle to navigate through the total occlusion of the left SFA and a selective diagnostic angio was performed at that location.  This also confirmed our location in the true lumen.  Now a  VIper wire was placed.  Gived the heavey calcification orbital atherectomy was planned. A clearway therapeutic infusion catheter was placed inside the left SFA and intraarterial abciximab and nitroglycerin were administered to prevent distal embolization.  Now orbital artherectomy of the left SFA, left pop artery. and the left common fem artery was performed using 1.25 and 2mm Predator solid crowns.  This was followed by balloon angioplasty of the left SFA, and the left pop artery.  Balloon angioplasty resulted in a very nice result in the left sfa and the left pop artery with excellent flow.  There was no stenting required.  Also, we performed balloon angioplasty of the left common fem artery which also resulted in an excellent result.  We also measured  a pressure gradient across the common fem artery and there was no pressure gradient remaining.  Now a 0.035 wire was placed through the sheath and the sheath was retrieved back into the common iliac artery.  At the very distal edge of the common iliac artery there was a 75% ulcerated lesion which caused a 70mm to 80mm pressure gradient.  Hence this lesion was treated using a 7 x 22 mm ICAST stent, the stent was post dilated via the  9mm. repeat angio demonstated excellent angiographic results.


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## dpeoples (Sep 30, 2010)

aforsythe said:


> I am hoping for some help, I haven't coded pheripherals for a while and want to make sure I still have an idea of whats going on.  Thanks for your help in advance, I really appreciate it.
> 
> sheath placed in the right common fem artery.  Subsequent to that, a 5-French scatheter was placed into the left common fem artery, and a selective diagnostic left lower extremity angiography was them performed.  This demonstrated 70% stenosis of the left common fem artery.  There was a pressure gradient across the left common iliac artery which was observed at the beginning of the procedure.  Left SFA contains diffuse calcific disease, however it is patent in the proximal and mid segment. The distal SFA is totally occluded in the short segment which is heavily calcified.  Left profunda femoris artery coontains 60% stenosis.  Left pop artery contains 75 - 80% lesion which is also diffusely diseased.  Left ant tibial artery is a small diffusely diseased vessel with multiplle subtotal occlusions.  Left peroneal artery is patent.  Left posterior tib artery is totally occluded.
> 
> At this point the patient was given IV heparin.  A 7-French contalateral sheath was placed into the left common fem artery.  Now an .035 quick cross catheter was positiioned into the left SFA and a selective additonal angio was performed at that location.  Now we were avle to navigate through the total occlusion of the left SFA and a selective diagnostic angio was performed at that location.  This also confirmed our location in the true lumen.  Now a  VIper wire was placed.  Gived the heavey calcification orbital atherectomy was planned. A clearway therapeutic infusion catheter was placed inside the left SFA and intraarterial abciximab and nitroglycerin were administered to prevent distal embolization.  Now orbital artherectomy of the left SFA, left pop artery. and the left common fem artery was performed using 1.25 and 2mm Predator solid crowns.  This was followed by balloon angioplasty of the left SFA, and the left pop artery.  Balloon angioplasty resulted in a very nice result in the left sfa and the left pop artery with excellent flow.  There was no stenting required.  Also, we performed balloon angioplasty of the left common fem artery which also resulted in an excellent result.  We also measured  a pressure gradient across the common fem artery and there was no pressure gradient remaining.  Now a 0.035 wire was placed through the sheath and the sheath was retrieved back into the common iliac artery.  At the very distal edge of the common iliac artery there was a 75% ulcerated lesion which caused a 70mm to 80mm pressure gradient.  Hence this lesion was treated using a 7 x 22 mm ICAST stent, the stent was post dilated via the  9mm. repeat angio demonstated excellent angiographic results.



here goes:
36247/75710-59
35493/75992 LCFA
35493-59/75993 LSFA
35493-59/75993 LPOP
35474/75962 LCFA
35474-59/75964 LSFA
35474-59/75964 LPOP
37205/75960 LCIA

You may also need to append modifier 76 to the subsequent atherectomy and angioplasty codes, depending on your payor.

It is early, I hope I did not miss anything.

HTH


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