# Angioplasty



## prabha (Sep 25, 2009)

Can anyone suggest me the codes for the below procedure?

STUDY:  Bilateral common iliac angioplasty and stent placement, and left
profunda femoris artery angioplasty.
CLINICAL INDICATION:  Profound ischemia involving left lower extremity
status post attempted placement of aortoiliac stents.
groins were prepped and draped in sterile fashion.  The skin was
anesthetized with 1% lidocaine.  Contrast injection revealed patency of
the left common iliac stent-graft.  However, there was very sluggish flow
with very poor inflow.  High-grade stenosis involving the profunda
femoris was identified.
Attempts were made at selectively catheterizing the left iliac stent from
the right femoral approach using a #5-French rim catheter, without
success.  Following this, attempts were made at selectively catheterizing
the right common iliac artery from the left femoral approach, again
without success, using both a #5-French rim catheter and a #5-French
Simmons glide catheter.  This was as the result of a preexisting
retrograde dissection involving the distal abdominal aorta.
Finally, #7-French sheaths were placed via both groins by upsizing the
right and a 15-mm Amplatz loop snare used to snare a wire from the right
common femoral artery placed in the descending thoracic aorta from the
left lower approach.  This allowed for withdrawal of a catheter into the
left iliac stent-graft from the right femoral approach.  Using this
access, a 4 mm angioplasty was performed over a .018-inch wire of the
proximal profunda femoris.  There remained poor inflow.  This information
was discussed with Dr. Thompson, referring vascular surgeon.
Decisions were made to perform bilateral common iliac artery angioplasty
and stent placements.  The descending thoracic aorta was selectively
catheterized and .035-inch Amplatz superstiff wires placed.  Free
angioplasty with 6 mm angioplasty was performed.  Following this, 10 mm
in diameter x 39 mm in length stents were placed from the distal
abdominal aorta to the common iliac arteries bilaterally.  Additional
extension with a 20-mm stent was placed to provide for excellent flow
through the left common iliac stent-graft.  Following the procedure, the
catheter and sheaths were removed and pressure applied to both groins for
one-half hour.  There was excellent femoral pulse through the left common
femoral artery at the completion of the procedure.  The patient had a
moderate proximal left thigh hematoma.  There remained profound ischemia
involving the left lower extremity below the knee.  The patient was
transferred to the Intensive Care Unit with generally improved left
femoral pulse and no other significant change in her hemodynamic status.
IMPRESSION:  Status post bilateral aortoiliac stents and angioplasty with
left profunda femoris angioplasty, as described above.


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## dpeoples (Sep 25, 2009)

prabha said:


> Can anyone suggest me the codes for the below procedure?
> 
> STUDY:  Bilateral common iliac angioplasty and stent placement, and left
> profunda femoris artery angioplasty.
> ...




The guidelines are that you can bill for angioplasty prior to stent placement as long as suboptimal results are documented. There is only one instance of this in the note. So...

37205/75960
37206/75960
35474/75962
36245 
36200-59 (catheter/access documentation could be clearer and may allow for higher order code)

I see no documentation of images performed prior to intervention.
HTH


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## prabha (Sep 29, 2009)

Thanks Danny.....


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