RadCoder56
New
Can you code 36200, 36246 & 37227 together or does 37227 include catheter placement (36246)? Any help would be appreciated 
SPECIFICS OF PROCEDURE:
After obtaining written consent, the patient was brought to the Angio suite and
placed on the table in the supine position. Prep and drape was performed in the
usual aseptic fashion. Timeout was performed. IV sedation was initiated. \
A single wall puncture technique was used to gain access to the right common
femoral position. This was done under direct ultrasound guidance. A 5 French
sheath was placed. Omniflush catheter was placed in the aorta and half strength
contrast was used to perform AP aortogram, and then the catheter repositioned at
the terminal aorta for obliques of the pelvis. Then proximal and distal views
of the thighs. Inadequate opacification was seen in the distal tibials. The
decision was made to intervene.
A regular Glidewire was used to deflect the OmniFlush catheter into the external
iliac on the patient's left, and then a stiff angled Glidewire subsequently
placed with removal of the Omni Flush and then the 5 French sheath with
placement of a 55 cm Rabbi 6 French sheath into the SFA on the left. 5000 units
of IV heparin had been given and 1 gram of Ancef.
Utilizing an 0.014, command 300 cm wire and 0.014 quick cross catheter, these
lesions were traversed, with intraluminal position confirmed through the quick
cross catheter beyond the popliteal stenosis. A Viper wire was subsequently
placed and a 2.0 classic device subsequently selected for use and orbital
atherectomy performed to the superficial femoral and popliteal position. This
was removed and then a 4 x 220 savvy balloon placed in the mid popliteal and
injected and walked backward, and then a 5 x 220 balloon insufflated as the plan
was for Supera stent placement of a larger insufflation and PTO was desired.
This was performed again from the mid popliteal on backward. This was removed,
and a followup injection performed, demonstrating again flow-limiting stenosis
in the popliteal and SFA positions.
A 4.5 x 100 mm Supera stent was then selected for use and deployed from mid
popliteal and then back with magnification. This was performed without incident.
A subsequent view was subsequently then performed over the area of interest in
the SFA adductor canal on magnification, and a 5.5 x 150 Supera stent selected
for use. The area between these was approximately 3 cm. Deployment was performed
here again without incident. An injection run was then performed without
magnification through the sheath demonstrating wide patency with no need for
ballooning of the proximal end of the stent. There was good flow into the foot.
There appeared to be potentially a flap in between these two stents, but this
was not the case, done on multiple views. A stiff angle Glidewire was placed
through the sheath, which was pulled back and exchange made for a Star closure
device. This was deployed without incident in the right common femoral position.
There were no immediate complications.
SPECIFICS OF PROCEDURE:
After obtaining written consent, the patient was brought to the Angio suite and
placed on the table in the supine position. Prep and drape was performed in the
usual aseptic fashion. Timeout was performed. IV sedation was initiated. \
A single wall puncture technique was used to gain access to the right common
femoral position. This was done under direct ultrasound guidance. A 5 French
sheath was placed. Omniflush catheter was placed in the aorta and half strength
contrast was used to perform AP aortogram, and then the catheter repositioned at
the terminal aorta for obliques of the pelvis. Then proximal and distal views
of the thighs. Inadequate opacification was seen in the distal tibials. The
decision was made to intervene.
A regular Glidewire was used to deflect the OmniFlush catheter into the external
iliac on the patient's left, and then a stiff angled Glidewire subsequently
placed with removal of the Omni Flush and then the 5 French sheath with
placement of a 55 cm Rabbi 6 French sheath into the SFA on the left. 5000 units
of IV heparin had been given and 1 gram of Ancef.
Utilizing an 0.014, command 300 cm wire and 0.014 quick cross catheter, these
lesions were traversed, with intraluminal position confirmed through the quick
cross catheter beyond the popliteal stenosis. A Viper wire was subsequently
placed and a 2.0 classic device subsequently selected for use and orbital
atherectomy performed to the superficial femoral and popliteal position. This
was removed and then a 4 x 220 savvy balloon placed in the mid popliteal and
injected and walked backward, and then a 5 x 220 balloon insufflated as the plan
was for Supera stent placement of a larger insufflation and PTO was desired.
This was performed again from the mid popliteal on backward. This was removed,
and a followup injection performed, demonstrating again flow-limiting stenosis
in the popliteal and SFA positions.
A 4.5 x 100 mm Supera stent was then selected for use and deployed from mid
popliteal and then back with magnification. This was performed without incident.
A subsequent view was subsequently then performed over the area of interest in
the SFA adductor canal on magnification, and a 5.5 x 150 Supera stent selected
for use. The area between these was approximately 3 cm. Deployment was performed
here again without incident. An injection run was then performed without
magnification through the sheath demonstrating wide patency with no need for
ballooning of the proximal end of the stent. There was good flow into the foot.
There appeared to be potentially a flap in between these two stents, but this
was not the case, done on multiple views. A stiff angle Glidewire was placed
through the sheath, which was pulled back and exchange made for a Star closure
device. This was deployed without incident in the right common femoral position.
There were no immediate complications.