# Vertebral Artery stenting-- HELP!



## sslater (Jan 30, 2014)

I am needing help with this OP note for a vertebral artery PTA/Stenting..  

HISTORY:  Patient is a 64 year old lady who is complaining of
posterior cerebral separation symptoms.  She was found by CT angiogram
to have 100% right subclavian artery occlusion and 70% left vertebral
artery occlusion.  The patient was scheduled today to have
brachiocephalic and left subclavian and vertebral artery angiogram
with or without intervention

PROCEDURES PERFORMED:
1. Aortogram.
2. Right brachiocephalic angiogram.
3. Left subclavian angiogram.
4. Nonselective left vertebral artery angiogram.

ACCESS SITE: Right femoral artery.

ACCESS SHEATH:  Diagnostic images were performed using 5 French sheath
and the intervention with 6 French long sheath 90cm.

LOCAL ANESTHESIA:  1% Lidocaine.

SEDATION: Achieved with Versed and Fentanyl.

DESCRIPTION OF THE PROCEDURE:  Patient was brought to the
Catheterization Laboratory in the fasting state.  She was draped in
the usual sterile manner on the procedure table.  Monitoring devices
were afixed to the patient.  Time out was performed. The access site
was anesthetized with Lidocaine.  Using modified Seldinger technique
access was gained and then the sheath was placed over a wire.  Blood
was aspirated through the side port and catheter flushed with sterile
saline.  Under fluoroscopic guidance and over a 0.035 wire the
catheter was advanced to the area of study.
HEMODYNAMIC FINDINGS:
Aortic systolic pressure 168mmHg.  Aortic diastolic pressure 97mmHg.
and the aortic mean pressure 97mmHg.

RADIOGRAPHIC FINDINGS:

AORTOGRAM:  Aortogram was performed using 5 French pigtail and in LAO
40 position.  It showed common origin of the brachiocephalic artery
and the left carotid artery.  It showed angiographically normal
proximal segment of both the brachiocephalic and left carotid artery.
The proximal segment of the left subclavian artery is angiographically
normal.

BRACHIOCEPHALIC ANGIOGRAM:  This showed minimal disease in the
brachiocephalic trunk less than 25% and also minimal disease in the
common carotid artery less than 25%.  There was 100% total occlusion
of the right subclavian artery at the ostium. The right subclavian
artery reconstitutes from collateral before the origin of right
vertebral artery.

LEFT SUBCLAVIAN ARTERY ANGIOGRAM:  Showed luminal irregularities in
the left subclavian artery. There was 80% hazy stenosis in the very
proximal, early proximal segment of the vertebral artery in the V1
segment.  Follow up run off of the left vertebral artery showed
limited retrograde flow to the right vertebral artery and earlier
angiogram of the brachiocephalic actually showed that the right
subclavian artery is getting collateral from small vessel unrelated to
the carotid artery or the vertebral artery.

DESCRIPTION OF THE INTERVENTION:  6 French 90cm sheath was used and
placed in the proximal left subclavian artery.  Anticoagulation was
achieved with IV Heparin.   Using 0.035 wire and Headhunter catheter
the sheath was advanced close to the origin of the left vertebral
artery.  The filter wire embolic protection was placed in the
vertebral artery distal to the lesion.  A Trek 3.0 x 12 balloon was
used and inflated twice up to 8 atmospheres.   Follow up angiogram
showed good flow.  Vision stent 4.0 x 18 was used and stenosis was
reduced from 80% to 0%.  Follow up angiogram showed good flow distally
in the left posterior circulation.  Next the filter was captured and
follow up angiogram showed good angiographic results with good flow in the left vertebral artery with no dissection, perforation or distal
embolization.

INTRAVENOUS CONTRAST USED:  170ml.

RADIATION TIME:  20 minutes.

BLOOD LOSS:  Minimal less than 25cc.

COMPLICATIONS:  None.

*FINAL IMPRESSION:
Successful balloon angioplasty and stenting to the left vertebral
artery early proximal stenosis in the V1 segment.*

I keep going to the 0075T for the stenting but i'm not sure.  Is there another CPT code i should use for this?


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## TerryFletcherCPC (Jan 31, 2014)

*Vertebral Stenting*

You are correct, only the 0075T code can be used here. However, if you read the description of this code, there is no mention of PTA when performed. You may be able to capture 35475 and 75962.26 for the brachiocephalic PTA (includes trunk and branches). Depends on the payer


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## sslater (Feb 5, 2014)

Thank you so much for pointing that out..


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