Coding Corner: Keep Your Peripheral Vascular Coding In Line

Sharpen your expertise with this case study

Reporting peripheral vascular    procedures, such as angioplasties, catheter placements, and stent insertions, gets tricky when you don't know how to filter through the chart properly. See if you can identify the vital information - and avoid the coding traps - in this complicated case study.
History: A 73-year-old male with insulin-dependent diabetes and heart disease had a percutaneous transluminal coronary angioplasty (PTCA) three years ago. She now has drug-resistant hypertension, and testing indicates probable renal artery stenosis.
Operative report: Physician draped and prepped right groin area and introduced a pigtail catheter to the aorta through a retrograde right common femoral artery puncture. Then performed a flush abdominal aortogram.
Physician's identification of the right and left renal systems revealed high-grade stenosis of the orifice of the left renal artery. The physician then decided to use a curved catheter and performed both a left renal arteriogram and a left renal artery cannulation. She visualized the right renal artery from the flush abdominal aortogram. The artery and its branches were within normal limits.
The physician placed the catheter in the origin of the left renal artery, and then advanced a wire into an intrarenal branch and made exchange for a long sheath. She gave the patient 5,000 units of intravenous heparin. Physician introduced guidewire and PTA balloon catheter into the stenosis. Performed initial angioplasty with balloon. Upsized balloon; performed another dilation at the proximal stenosis site in the left renal artery. Performed a final arteriography, which showed no residual stenosis and smoothly flowing contrast through left renal artery and parenchymal bed.
How should you report these procedures?
Dilute Procedures to Core Info
Each word of the operative report doesn't deserve equal amounts of your attention - and the first step to translating physician documentation into information you can use is to determine exactly which procedures the doctor performed. In this patient's case, there are seven distinct parts to the operation:

  right common femoral access
  flush aortogram
  left renal artery, selective
  left renal arteriogram
  renal angioplasty (smaller balloon)
  renal angioplasty (larger balloon)
  final arteriography, after angioplasty.
Instead of immediately searching for corresponding codes for all of  these procedures, you may want to extract a few key terms that will help you decide what information is useful, says Gary Burns, MBA, RHIA, CIC, with Medical Asset Management Inc. in Atlanta, who presented on peripheral vascular coding at an American Health Information Management Association meeting.
For example, with this patient, you'll need to know the catheter insertion point, catheter end point, all vessels the physician catheterized, all vessels she visualized, and any abnormal anatomy.
Know Procedures to Report
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- Published on 2004-09-11