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Help please in coding this procedure
Procedure: Selective engagement and angiography of the second order thoracic vessels of the left internal mammary artery as well as the right internal mammary artery.
Indications: AP and chest wall injury, Preop coronary artery bypass grafting.
HPI: 73 year-old with newly appreciated cardiomyopathyand severe multivessel coronary disease. History of chest wall injury when he was 6. Likewise, he had vein stripping of lower extremities that had been done electively. Pt was brought for diagnostic angiography of his internal mammary arteries to determine whether or not they are patent and represent potential bypass conduits.
Procedure: Right groin was prepped in the usual sterial fashion and 2% lidocaine infused subcutaneously until adequate anesthesia was obtained. Right common femoral artery was accessed using modified Seldinger technique of which a French sheath was placed. An IMA catheter was used for selective angiography. After access to the arterial system, the wire was then advanced and placed to the distal subclavian. There was significant subclavian tortuosity; however, the wire easily traversed. A 5-French catheter was then used to selectively engage the internal mammary artery off the subclavian artery. This was used to perform selective angiography in the AP position, which demonstrated the vessel was patent without significant intervening disease and away from the sternum. It's course carried down distally. Attention was then drawn to the right internal mammary artery. Again, significant subclavian tortuosity was encountered. A Terumo Glidewire was then used to navigate the vessel and place the catheter to allow for selective engagement of the right internal mammary artery, which is off the subclavian artery. This too received selective injection that demonstrated patent vasculature without intervening stenosis
Coding:
36140 414.00 413.9 428.0 V72.81
36217-26 414.00 413.9 428.0 V72.81
36218-26 414.00 413.9 428.0 V72.81
75756-59 414.00 413.9 428.0 V72.81
75774-59 414.00 413.9 428.0 V72.81
Thanks Nancy
Procedure: Selective engagement and angiography of the second order thoracic vessels of the left internal mammary artery as well as the right internal mammary artery.
Indications: AP and chest wall injury, Preop coronary artery bypass grafting.
HPI: 73 year-old with newly appreciated cardiomyopathyand severe multivessel coronary disease. History of chest wall injury when he was 6. Likewise, he had vein stripping of lower extremities that had been done electively. Pt was brought for diagnostic angiography of his internal mammary arteries to determine whether or not they are patent and represent potential bypass conduits.
Procedure: Right groin was prepped in the usual sterial fashion and 2% lidocaine infused subcutaneously until adequate anesthesia was obtained. Right common femoral artery was accessed using modified Seldinger technique of which a French sheath was placed. An IMA catheter was used for selective angiography. After access to the arterial system, the wire was then advanced and placed to the distal subclavian. There was significant subclavian tortuosity; however, the wire easily traversed. A 5-French catheter was then used to selectively engage the internal mammary artery off the subclavian artery. This was used to perform selective angiography in the AP position, which demonstrated the vessel was patent without significant intervening disease and away from the sternum. It's course carried down distally. Attention was then drawn to the right internal mammary artery. Again, significant subclavian tortuosity was encountered. A Terumo Glidewire was then used to navigate the vessel and place the catheter to allow for selective engagement of the right internal mammary artery, which is off the subclavian artery. This too received selective injection that demonstrated patent vasculature without intervening stenosis
Coding:
36140 414.00 413.9 428.0 V72.81
36217-26 414.00 413.9 428.0 V72.81
36218-26 414.00 413.9 428.0 V72.81
75756-59 414.00 413.9 428.0 V72.81
75774-59 414.00 413.9 428.0 V72.81
Thanks Nancy