I need help, please, in coding this!
Surgery date: 06/18/2012
1. Aortogram with bilateral runoffs
2. Abdominal aortogram.
3. Selective left femoral arteriogram.
4. Selective right femoral arteriogram.
5. Angio-seal closure of the arteriotomy.
reason for the procedure: The pt. Has long history of coronary artery disease. Most recently had neen having significant leg pain with exertion. Claudication that occurred approximately after one block mostly on the left side and was also occurring on the right side, and so it was decided to proceed with an aortogram and a distal selective iliac arteriogram with distal followthrough.
hemodynamic findings: Blood pressure was 150/73 and the left femoral artery was 147/66.
angiographic findings: The patient was taken to the tca catheterization laboratory in a postprandial state. His right groin was cleaned and draped in the usual manner and anesthetized with 20 cc of 2% xylocaine. Femoral artery was easily cannulated and a #5 sheath was positioned in it. The abdominal aortogram was performed in dsa and this showed nonocclusive disease in the aorta and both renal arteries were patent. A second abdominal aortogram with bilateral runoffs was performed. The right superficial femoral exhibited a 90% stenosis in the mid portion. Also, on the right side, the posterior tibial and the peroneal were 100% occluded. On the left side, there was a 90% occlusion of the mid portion of the superficial femoral and the popliteal was 100% occluded and the reconstitution was into the anterior tibial and the peroneal. The posterior tibial was 100% occluded. There was another selective femoral arteriogram performed behind the patient has a left femoral head. The patient had a hip surgery with a left femoral head replacement and therefore left femoral arteriogram was performed because that area was not seen in the abdominal aortogram with runoffs in the ap projection; however, in the rao projection, the selective arteriogram of the left femoral arteriogram showed nonocclusive disease in the area behind the femoral head. A right femoral angiogram was performed to evaluate for closure device placement. Angio-seal was done to close the arteriotomy. The patient tolerated the procedure well.
plan: Most likely roto-ablation with balloon of the both superficial femorals and possibly of the left popliteal.