# Peripheral Angioplasty



## OPENSHAW (Oct 3, 2012)

Help!
Our doctor did iliacs-right, iliacs w/ runoffs-right, and PTA of right SFA X 3.

OP REPORT READS:
INDICATION FOR PROCEDURE:  SEVERE CLAUDICATION OF THE RIGHT LOWER EXTREMITY.  ABNORMAL DOPPLER STUDIES.

DESCRIPTION OF PROCEDURE:  
Under local anesthetic, utilizing 2% Xylocaine the left femoral artery was cannulated and a 6-French sheath was introduced.  The short internal mammary was utilized in order to cannulate selectively the right iliac artery.  This was done with a Wholey wire.  The catheter was advanced into the common iliac where same injection was done, injecting 35 ml of Visipaque, with runoff down to the toes.  Once this was done, several lesions in the femoral artery were identified.  The patient had previous stents deployed in the superficial femoral artery that had a high degree of restenosis in the distal portion of the most distal stent.  It was decided then to perform peripheral angioplasty.  A 7 x 4 balloon was utilized.  It was inflated until complete resolution of the obstruction was achieved.  A pullback across was done and it was placed in the 2nd stent that also had some degree of restenosis.  Again it was inflated until the obstruction was abated.  It was noted that proximally there was a lesion in the superficial femoral artery.  This was also angioplastied with the balloon inflated to 6 atmospheres.  After that procedure the repeat injection disclosed an excellent angiographic result.  Prior to the procedure the sheath was exchanged for a short sheath 45 cm destination sheath.  This allowed the deployment of the balloon.  After the procedure, the wire was placed in the ascending aorta and the sheath was exchanged for a 7-French short sheath.  After that, the wire was removed and the patient was sent to the hoding area to achieve hemostasis.  The patient tolerated the procedure very well and the result was angiographically good.


----------



## theresa.dix@tennova.com (Oct 4, 2012)

OPENSHAW said:


> Help!
> Our doctor did iliacs-right, iliacs w/ runoffs-right, and PTA of right SFA X 3.
> 
> OP REPORT READS:
> ...



For this one:

75710-26-59
37224


----------



## OPENSHAW (Oct 4, 2012)

What if this is all the operative report showed and there is no report reg. Code 75710.  Code 75710 bundles to code 37224.  
Why is code 75710 a distinct procedural service since modifier 59 would have to be attached.  Does code 75710 show to be a distinct service based on this op report?  What do you think?
Thanks!


----------



## Jim Pawloski (Oct 4, 2012)

OPENSHAW said:


> What if this is all the operative report showed and there is no report reg. Code 75710.  Code 75710 bundles to code 37224.
> Why is code 75710 a distinct procedural service since modifier 59 would have to be attached.  Does code 75710 show to be a distinct service based on this op report?  What do you think?
> Thanks!



The modifier 59 will tell insurance that a diagnostic arteriogram was performed before the intervention.
Thanks,
Jim Pawloski, CIRCC


----------



## theresa.dix@tennova.com (Oct 5, 2012)

OPENSHAW said:


> What if this is all the operative report showed and there is no report reg. Code 75710.  Code 75710 bundles to code 37224.
> Why is code 75710 a distinct procedural service since modifier 59 would have to be attached.  Does code 75710 show to be a distinct service based on this op report?  What do you think?
> Thanks!



What I think is what Jim said. You can go ahead and bill the S&I code 75710 because  distinct separate diagnostic study performed.

Maybe this will help. read carefully.

Diagnostic angiograms (75710) performed at the time of an interventional procedure may be separately reported if:

No prior catheter-based angiographic study is available and a full diagnostic study is performed and the decision to intervene is based on the diagnostic study. 



OR 
A prior study is available but as documented in the medical record: 
The patients condition has changed since the prior study 
There is inadequate visualization of the anatomy and/or pathology 
There is a clinic change during the procedure that requires a new evaluation outside the target area of intervention 
One of these conditions should be documented in the operative note; ideally in indications section. It must be clear that one of these conditions existed to justify a diagnostic study at the same time as an intervention.

-NOTE-

In your report here as said above-No prior catheter-based angiographic study is available and a full diagnostic study was performed and the decision to intervene is based on the diagnostic study. Right?

I hope that helps you to understand. If not let me know.


----------

