We have a cardiovascular surgeon who does periodic Duplex Sonography on her graft patients. If there are reason to indiciate a stenosis she brings them in for an angiogram.
In this particular case the the area of interest in the Tibial arteries. She stick the graft and does and angio of only the tibal artery. Then preceeds to itnerevention. I don't think this constitutes a full 75710. How would you code for this tyoe of case. We had three last week.
here is report:
Anesthesia: Monitored Local Anesthesia with Sedation
Procedures: 1. Promus stent placement left posterior artery
2. Angioplasty of the posterior tibial artery
3. Selective left leg angiogram
4. Conscious sedation x 50 min
Indications: Significant stenosis of posterior tibial artery (by duplex sonography)
Disposition: ASD
Condition:stable
Risks covered with, and accepted by, patient, and include, thrombosis, bleeding, infection, nerve injury, embolization, limb ischemia, cardiopulmonary complications, contrast-induced nephropathy.
Procedure Report:
The patient was brought to the angiogram suite. Continuous monitoring with pulse oximetry, and frequent heart rate and blood pressure monitoring ensued throughout the procedure. Sedation constituted of incremental doses of 1mg Versed and 50 mcg of Fentanyl.
The left leg was prepped in its medial aspect above the knee, and draped in the usual sterile fashion. Time out was conducted and agreed upon by all members of the team.
The skin overlying the graft was infiltrated with 1% Lidocaine without epinephrine, and the graft punctured with a micropuncture needle. An .035 glide wire was inserted into the graft and the needle exchanged for a 4F sheath. Multiple AP and oblique views of the distal femoral to posterior tibial artery, and tibial artery were obtained. A diffuse stenosis was seen distal to the graft. In fact, approximately 15 cm of vessel was very narrowed. Therefore the patient was given 5,000 units of heparin intravenously. A 014 Choice PT wire was passed across the anastomosis followed by a 2x120 Fox SV balloon. The vessel was angioplastied with no residual stenosis,but because this lesion reccurred to near occclusion within 2 months of a previous angioplasty, I decided to treat the most severe portion of the stenosis with a medicated Promus stent (3x38mm). There was no residual stenosis at the completion of the exam. The catheter was then removed as was the sheath once the ACT was less than 170. Pressure was applied to the puncture site. The patient was taken to the outpatient unit in stable condition.
Impression:
Critical, recurrent long stenoses of the left posterior tibial artery which was successfully angioplastied and stented.
In this particular case the the area of interest in the Tibial arteries. She stick the graft and does and angio of only the tibal artery. Then preceeds to itnerevention. I don't think this constitutes a full 75710. How would you code for this tyoe of case. We had three last week.
here is report:
Anesthesia: Monitored Local Anesthesia with Sedation
Procedures: 1. Promus stent placement left posterior artery
2. Angioplasty of the posterior tibial artery
3. Selective left leg angiogram
4. Conscious sedation x 50 min
Indications: Significant stenosis of posterior tibial artery (by duplex sonography)
Disposition: ASD
Condition:stable
Risks covered with, and accepted by, patient, and include, thrombosis, bleeding, infection, nerve injury, embolization, limb ischemia, cardiopulmonary complications, contrast-induced nephropathy.
Procedure Report:
The patient was brought to the angiogram suite. Continuous monitoring with pulse oximetry, and frequent heart rate and blood pressure monitoring ensued throughout the procedure. Sedation constituted of incremental doses of 1mg Versed and 50 mcg of Fentanyl.
The left leg was prepped in its medial aspect above the knee, and draped in the usual sterile fashion. Time out was conducted and agreed upon by all members of the team.
The skin overlying the graft was infiltrated with 1% Lidocaine without epinephrine, and the graft punctured with a micropuncture needle. An .035 glide wire was inserted into the graft and the needle exchanged for a 4F sheath. Multiple AP and oblique views of the distal femoral to posterior tibial artery, and tibial artery were obtained. A diffuse stenosis was seen distal to the graft. In fact, approximately 15 cm of vessel was very narrowed. Therefore the patient was given 5,000 units of heparin intravenously. A 014 Choice PT wire was passed across the anastomosis followed by a 2x120 Fox SV balloon. The vessel was angioplastied with no residual stenosis,but because this lesion reccurred to near occclusion within 2 months of a previous angioplasty, I decided to treat the most severe portion of the stenosis with a medicated Promus stent (3x38mm). There was no residual stenosis at the completion of the exam. The catheter was then removed as was the sheath once the ACT was less than 170. Pressure was applied to the puncture site. The patient was taken to the outpatient unit in stable condition.
Impression:
Critical, recurrent long stenoses of the left posterior tibial artery which was successfully angioplastied and stented.