bennieyoung
Guru
I coded this note as 37224, 75710-26,59 and 75630-26,59
Now I'm second guessing myself.
And while I think that the 75710 would also be separately billable from the 37224 and eligible for the -59 modifier I’m a little less clear on whether it is separately billable from the 75630. There is also a CCI edit for 75630 and 75710 with 75630 as the column 2 code. The description of the edit is that these are mutually exclusive codes.
Does this cover the catheter movement requirement to be able to code 75710 with 75630? Catheter placement in right common femoral artery and Catheter placement in the right distal superficial femoral artery
INDICATIONS FOR PROCEDURE:
Non-healing ulceration, right foot.
PROCEDURE:
1. Nonselective left groin sheathogram.
2. Runoff of both lower extremities.
3. Abdominal aortogram.
4. Catheter placement in right common femoral artery.
5. Runoff of right lower extremity.
6. Catheter placement in the right distal superficial femoral artery.
7. Percutaneous transluminal angioplasty of right superficial femoral artery with a 5.0 x 150 mm balloon with multiple sequential inflations throughout the length of the superficial femoral artery.
HISTORY: Briefly, this is a 77-year-old female with history of ulceration between her big and 4th toe, which has been getting worse, causing extreme pain. The patient had ABIs, which were markedly abnormal in the right lower extremity. Given these findings, patient consented for invasive angiography.
DESCRIPTION OF PROCEDURE: After informed consent, patient was brought to BCH where the left arm was prepped and draped in sterile fashion. Using lidocaine, a short 6-French sheath in the left common artery verified angiographically. A runoff of the left lower extremity was performed, which showed patent left common femoral artery. The profunda had, what appeared to be, a very high takeoff in the midfemoral head. The SFA proximally had diffuse 30% disease. In the midbody of SFA, there was more high-grade disease ranging up to 60% in Hunter canal. The popliteal artery was obscured slightly by a prosthesis; however, it appeared to be widely patent going into, what appeared to be initially, trifurcation. At the ostium of the trifurcation, there was 40% disease. The 3 vessels then ran to the foot and the posterior tibial artery and anterior tibial artery appeared to be widely patent, running all the way to the foot. After this, the Universal flush catheter was advanced to the descending aorta. Abdominal aortogram showed widely patent distal aorta, calcified plaque in the right common iliac artery but was not obstructing. Patent left common iliac artery. Patent bilateral internal iliac arteries. Widely patent external iliac arteries bilaterally. Widely patent right common femoral artery with, again, a high takeoff of the profunda artery. Universal flush catheter was advanced to the right common femoral artery where runoff of the right lower extremity was obtained, which showed patent proximal right CFA with a high takeoff of the profunda artery. The proximal SFA had tubular 30% to 40% disease entering into an area in the mid SFA of higher grade 50% disease to a focal area of 70% disease and then finally at Hunter canal, in the area of at least 90% stenosis with a channel leading to the distal SFA. The patient had a right knee procedure. Right above this area, there was an initial area of 60% to 70% disease. Of note, behind the prosthesis, it was unclear if there was true flow through a popliteal artery proper as there was no evidence of inline flow from the SFA into the infrapopliteal vessels. There was robust and large collaterals coming from the SFA feeding the anterior tibial artery, which again appeared to be a chronic occlusion. We angulated the camera to see if we could throw the prosthesis off to see a little bit more of where the popliteal artery may have been occluded. However, again, this was very difficult to ascertain as it appeared that there was a mesh of collaterals right behind the knee coming from the SFA, which then robustly filled the infrapopliteal vessels. The runoff of the anterior tibial artery was widely patent, and actually, the posterior tibial artery was also reconstituted by collaterals at the midshin level, and both arteries ran intact to the foot.
INTERVENTION REPORT: At this time, we decided that the most likely target for the patient's intervention would be her high-grade disease in her SFA as the popliteal artery issues appeared to be chronic in nature with robust collateralization provided by the SFA. A long angled stiff wire was advanced into the SFA. The Universal flush catheter was removed. The short 6-French sheath was removed. A 6-French 45 Destination sheath was then placed in the right ostium of the common femoral artery verified angiographically. The patient was administered 7000 heparin IV with ACTs being checked every 15 minutes thereafter to maintain ACT greater than 250. The 0.035 wire with a Glide catheter support was able to cross the lesion in the distal SFA. We then placed a wire in the distal SFA right at the level of the prosthesis prior to the collateralization of the popliteal artery. We then proceeded with balloon inflation with a 5.0 x 150 mm Boston Scientific balloon placed at the distal SFA and inflated up to 6 atmospheres, which was kept up for 1 minute's time. We then repeated this inflation in the mid SFA with the same inflation rate and time and then finally in the proximal SFA with the same inflation rate and time. After this was performed, angiographic images were then obtained, which showed excellent flow through the SFA with no major dissection planes with much more robust flow through the entire length of the SFA into the collateralized popliteal artery running to the 2-vessel runoff to the foot. At this time, we decided that no further intervention would be warranted at this time. The balloon was removed. The Destination sheath was removed and closed with a 6-French Angio-Seal. The patient tolerated the procedure well with no complications.
IMPRESSION: Successful recannulization of high-grade right superficial femoral artery disease, which collateralized the popliteal artery and ends with 2-vessel runoff to the foot.
Now I'm second guessing myself.
And while I think that the 75710 would also be separately billable from the 37224 and eligible for the -59 modifier I’m a little less clear on whether it is separately billable from the 75630. There is also a CCI edit for 75630 and 75710 with 75630 as the column 2 code. The description of the edit is that these are mutually exclusive codes.
Does this cover the catheter movement requirement to be able to code 75710 with 75630? Catheter placement in right common femoral artery and Catheter placement in the right distal superficial femoral artery
INDICATIONS FOR PROCEDURE:
Non-healing ulceration, right foot.
PROCEDURE:
1. Nonselective left groin sheathogram.
2. Runoff of both lower extremities.
3. Abdominal aortogram.
4. Catheter placement in right common femoral artery.
5. Runoff of right lower extremity.
6. Catheter placement in the right distal superficial femoral artery.
7. Percutaneous transluminal angioplasty of right superficial femoral artery with a 5.0 x 150 mm balloon with multiple sequential inflations throughout the length of the superficial femoral artery.
HISTORY: Briefly, this is a 77-year-old female with history of ulceration between her big and 4th toe, which has been getting worse, causing extreme pain. The patient had ABIs, which were markedly abnormal in the right lower extremity. Given these findings, patient consented for invasive angiography.
DESCRIPTION OF PROCEDURE: After informed consent, patient was brought to BCH where the left arm was prepped and draped in sterile fashion. Using lidocaine, a short 6-French sheath in the left common artery verified angiographically. A runoff of the left lower extremity was performed, which showed patent left common femoral artery. The profunda had, what appeared to be, a very high takeoff in the midfemoral head. The SFA proximally had diffuse 30% disease. In the midbody of SFA, there was more high-grade disease ranging up to 60% in Hunter canal. The popliteal artery was obscured slightly by a prosthesis; however, it appeared to be widely patent going into, what appeared to be initially, trifurcation. At the ostium of the trifurcation, there was 40% disease. The 3 vessels then ran to the foot and the posterior tibial artery and anterior tibial artery appeared to be widely patent, running all the way to the foot. After this, the Universal flush catheter was advanced to the descending aorta. Abdominal aortogram showed widely patent distal aorta, calcified plaque in the right common iliac artery but was not obstructing. Patent left common iliac artery. Patent bilateral internal iliac arteries. Widely patent external iliac arteries bilaterally. Widely patent right common femoral artery with, again, a high takeoff of the profunda artery. Universal flush catheter was advanced to the right common femoral artery where runoff of the right lower extremity was obtained, which showed patent proximal right CFA with a high takeoff of the profunda artery. The proximal SFA had tubular 30% to 40% disease entering into an area in the mid SFA of higher grade 50% disease to a focal area of 70% disease and then finally at Hunter canal, in the area of at least 90% stenosis with a channel leading to the distal SFA. The patient had a right knee procedure. Right above this area, there was an initial area of 60% to 70% disease. Of note, behind the prosthesis, it was unclear if there was true flow through a popliteal artery proper as there was no evidence of inline flow from the SFA into the infrapopliteal vessels. There was robust and large collaterals coming from the SFA feeding the anterior tibial artery, which again appeared to be a chronic occlusion. We angulated the camera to see if we could throw the prosthesis off to see a little bit more of where the popliteal artery may have been occluded. However, again, this was very difficult to ascertain as it appeared that there was a mesh of collaterals right behind the knee coming from the SFA, which then robustly filled the infrapopliteal vessels. The runoff of the anterior tibial artery was widely patent, and actually, the posterior tibial artery was also reconstituted by collaterals at the midshin level, and both arteries ran intact to the foot.
INTERVENTION REPORT: At this time, we decided that the most likely target for the patient's intervention would be her high-grade disease in her SFA as the popliteal artery issues appeared to be chronic in nature with robust collateralization provided by the SFA. A long angled stiff wire was advanced into the SFA. The Universal flush catheter was removed. The short 6-French sheath was removed. A 6-French 45 Destination sheath was then placed in the right ostium of the common femoral artery verified angiographically. The patient was administered 7000 heparin IV with ACTs being checked every 15 minutes thereafter to maintain ACT greater than 250. The 0.035 wire with a Glide catheter support was able to cross the lesion in the distal SFA. We then placed a wire in the distal SFA right at the level of the prosthesis prior to the collateralization of the popliteal artery. We then proceeded with balloon inflation with a 5.0 x 150 mm Boston Scientific balloon placed at the distal SFA and inflated up to 6 atmospheres, which was kept up for 1 minute's time. We then repeated this inflation in the mid SFA with the same inflation rate and time and then finally in the proximal SFA with the same inflation rate and time. After this was performed, angiographic images were then obtained, which showed excellent flow through the SFA with no major dissection planes with much more robust flow through the entire length of the SFA into the collateralized popliteal artery running to the 2-vessel runoff to the foot. At this time, we decided that no further intervention would be warranted at this time. The balloon was removed. The Destination sheath was removed and closed with a 6-French Angio-Seal. The patient tolerated the procedure well with no complications.
IMPRESSION: Successful recannulization of high-grade right superficial femoral artery disease, which collateralized the popliteal artery and ends with 2-vessel runoff to the foot.
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