ttglasscock
Contributor
I'm am trying to figure out if I need to code the PTA as an upper extremity 35475/75962 or use the lower extremity PTA 37224 for this bypass graft.
Please help!!
PROCEDURE: Angiography of ax-bifem bypass and bilateral lower extremities. PTA of axillary anastomosis
SURGEON: Schroder
ANESTHESIA: Local with moderate sedation
MEDICATION(S): Benadryl 50 mg. Versed 2 mg. Fentanyl 100 ?g. Heparin 5000 units
MALLAMPATI: II
ASA: III
INDICATION: 72-year-old gentleman with an old right axillary bifemoral bypass. He has had previous interventions. Surveillance disclosed stenosis at the axillary anastomosis and possibly the left femoral anastomosis
DETAILS: The patient and planned procedure were identified, and a "time-out" was taken.
Ax-bifem bypass along the right flank was prepped and draped. Micro puncture technique was used to enter the bypass proximally. 5 French sheath was placed. Catheter was advanced into the axillary artery and hand injected imaging of the axillary artery, axillary anastomosis, and long segment of the bypass was performed. Subsequent to the axillary intervention, the side arm of the sheath was injected to image the cross femoral portion and the runoff to the midcalf.
FINDINGS: Axillary artery patent. 60% stenosis at the anastomosis to the bypass. Ax-bifem is patent in its entirety. Both femoral anastomoses are patent without stenosis. A covered stent seems to be present at the level of the left femoral anastomosis. Bilaterally, the runoff consists of patent superficial and deep femoral arteries. Both popliteals are patent. Both trifurcation areas are patent.
TREATMENT: Heparin was given. 6 French sheath was placed. PTA of the axillary anastomosis was done with a 7.0 x 40 mm Armada balloon inflated at maximum atmospheres (7.7 mm). Excellent profile was achieved. Completion study showed excellent relief with less than 15% residual stenosis. No extravasation or damage.
Following imaging, devices were removed. Sheath was removed and pressure held until hemostasis was complete. Sterile dressing was applied. Patient was taken uneventfully to recovery for observation and subsequent discharge
CONTRAST: 35 ML
EBL: Minimal
IMPRESSION: Stenosis of the axillary anastomosis. Good result with PTA. Otherwise, the bypass graft is patent with excellent runoff as above.
PLAN: Office follow-up in about a month.
Please help!!
PROCEDURE: Angiography of ax-bifem bypass and bilateral lower extremities. PTA of axillary anastomosis
SURGEON: Schroder
ANESTHESIA: Local with moderate sedation
MEDICATION(S): Benadryl 50 mg. Versed 2 mg. Fentanyl 100 ?g. Heparin 5000 units
MALLAMPATI: II
ASA: III
INDICATION: 72-year-old gentleman with an old right axillary bifemoral bypass. He has had previous interventions. Surveillance disclosed stenosis at the axillary anastomosis and possibly the left femoral anastomosis
DETAILS: The patient and planned procedure were identified, and a "time-out" was taken.
Ax-bifem bypass along the right flank was prepped and draped. Micro puncture technique was used to enter the bypass proximally. 5 French sheath was placed. Catheter was advanced into the axillary artery and hand injected imaging of the axillary artery, axillary anastomosis, and long segment of the bypass was performed. Subsequent to the axillary intervention, the side arm of the sheath was injected to image the cross femoral portion and the runoff to the midcalf.
FINDINGS: Axillary artery patent. 60% stenosis at the anastomosis to the bypass. Ax-bifem is patent in its entirety. Both femoral anastomoses are patent without stenosis. A covered stent seems to be present at the level of the left femoral anastomosis. Bilaterally, the runoff consists of patent superficial and deep femoral arteries. Both popliteals are patent. Both trifurcation areas are patent.
TREATMENT: Heparin was given. 6 French sheath was placed. PTA of the axillary anastomosis was done with a 7.0 x 40 mm Armada balloon inflated at maximum atmospheres (7.7 mm). Excellent profile was achieved. Completion study showed excellent relief with less than 15% residual stenosis. No extravasation or damage.
Following imaging, devices were removed. Sheath was removed and pressure held until hemostasis was complete. Sterile dressing was applied. Patient was taken uneventfully to recovery for observation and subsequent discharge
CONTRAST: 35 ML
EBL: Minimal
IMPRESSION: Stenosis of the axillary anastomosis. Good result with PTA. Otherwise, the bypass graft is patent with excellent runoff as above.
PLAN: Office follow-up in about a month.