# Interventional cardiology coding



## amym (May 26, 2011)

Please help coding this scenario:

PROCEDURES PERFORMED: 
1. Abdominal aortogram with bilateral lower extremity runoff. 
2. Carotid arteriogram, selective. 
3. Laser atherectomy followed by percutaneous transluminal angioplasty 
of the left superficial femoral artery. 

CLINICAL SUMMARY:  The patient is a pleasant 68-year-old white female 
who presented with symptoms of claudication bilaterally.  Lately she has 
experienced episodes of dizziness and spells, which required her to be 
hospitalized at one time. 

PROTOCOL:  The patient was brought to the cath lab.  Both groins were 
prepped and draped in the usual sterile fashion.  Xylocaine was 
infiltrated for right femoral artery access with a single stick and a 5- 
French sheath inserted.  A 5-French OmniFlush catheter was advanced and 
an abdominal angiogram was performed followed by runoff using 80 mL of 
contrast, as well as chase method.  No complications occurred. 

FINDINGS: 
ABDOMINAL AORTOGRAM:  The abdominal aorta shows good caliber with mild 
atherosclerosis.  Bilateral and multiple renal arteries are patent but 
showing moderate disease.  Mesenteric artery shows proximal disease with 
calcification and may be of interest, if patient has symptoms of 
postprandial abdominal symptoms.   However, the severity of this lesion 
was not carefully assessed.  The bifurcation is intact with no 
significant disease involving the bifurcation. 

RIGHT LOWER EXTREMITY ARTERIOGRAM:  The right circulation reveals the 
following:  The right common iliac artery has a 60 to 70% narrowing at 
the very proximal part, which is showing evidence of ulceration.  The 
right common iliac leads up to patent external and internal iliac 
arteries.  The extremely big artery shows heavy disease up to 50% 
severity leading up to the bifuraction and the profunda and superficial 
femoral artery.  The superficial femoral artery in the proximal third 
shows very severe disease up to 90 to 95% severity.  The middle and 
distal third of the superficial femoral artery reveals moderate-heavy 
disease with up to 60 to 70% lesions and multiple 60% lesions in 
multiple places leading up to the popliteal artery, which is patent and 
leads to the trifucation.  The trifurcation reveals moderate disease 
with patency of all three vessels of the anterior tibial, posterior 
tibial and peroneal arteries are patent with three-vessel runoff to the 
distal leg. 

LEFT LOWER EXTREMITY ARTERIOGRAM:  The left circulation reveals the 
following:  The left common iliac artery shows mild to moderate 
atherosclerosis diffusely but large caliber with at least external iliac 
artery, which shows 50 to 60% heavy plaque with eccentric and tortuous 
vessel leading to bifurcation.  The superficial femoral artery reveals 
aggressive severe disease extending from the proximal part all the way 
to the popliteal with up to 90% stenosis in 2 or 3 spots.  The popliteal 
artery is relatively free of any disease and leads up to a trifucation, 
which is showing patent anterior tibial, posterior tibial and peroneal 
vessels with flow into the foot without any significant disease. 

I think it should be coded as followed:

1. 36245, 75630-26 - Abdominal aortogram with bilateral lower extremity runoff.  
2. 36216 - Carotid arteriogram, selective. 
3. 37225 - Laser atherectomy followed by percutaneous transluminal angioplasty 
of the left superficial femoral artery. 

I may be way off but would really appreciate your help!


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## Cyndi113 (May 26, 2011)

Your codes should be - 75630-26 + 36200. You cannot code the 36216 as the catheter did not enter either carotid. 

I'm not sure about the atherectomy because you didn't include the note. However, if the provider did an atherectomy, you may only code the 37225.


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## amym (May 31, 2011)

Sorry, this is the rest of the note!

CAROTID ARTERIOGRAM:  Carotid arteriogram was performed using the 
pigtail catheter to perform the left arteriogram, which visualized the 
arch and the great vessels, which appear to takeoff normally. 

SELECTIVE CAROTID ANGIOGRAPHY:  The selective angiography of the right 
and left carotid arteries was performed using a Headhunter catheter for 
the right and JL4 French catheter was the left.  Imaging was done in 
various angles and intracranial imaging was not performed. 

FINDINGS:  Reveal the right carotid shows evidence of 60% plaque, which 
is somewhat eccentric but excellent flow was noted into distal 
circulation.  The left common carotid artery shows a widely patent lumen 
with no only mild atherosclerosis.  The external carotid artery shows 
ostial disease of 70% of severity. 


LASER AND PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY ATHERECTOMY PROTOCOL: 
After the lesion was identified, it was felt the laser approach would be 
optimal due to the diffuse disease.  At this point, the 6-French 
Destination sheath was advanced and placed in the contralateral common 
femoral artery.  An 0.14 Sparta-Core guidewire was then advanced and 
taken across the lesion and then positioned in the left popliteal artery 
and then laser atherectomy was performed using 1.4 mm fiber and two 
passes were done throughout the entire superficial femoral artery and 
subsequently the 300 length 3 mm VascuTrac balloon was then advanced and 
positioned across the distal part of the superficial femoral artery and 
then pulled back covering the entire proximal part of the superficial 
femoral artery and multiple dilatations were performed.  Marked 
improvement was noted and there was no evidence of dissection and 
excellent flow was present with subsequent runoff was seen in the lower 
leg as well, which confirmed improvement.  At this point, the entire 
assembly was removed from the left superficial femoral artery, then 
multiple images were performed to ensure the flow was visualized well 
from the left external iliac artery.


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