I’m new to a vascular office and reviewing some denials. I’m reaching out for suggestions on improving charting for the surgeon. I’ve noticed that many of the codes are being denied, and I don't think the documentation aligns well with the CPT codes. I added the documentation and cpt codes below. Any help would be appreciated!
PROCEDURES
Ultrasound-guided access right common femoral artery.
Abdominal angiogram with the catheter was in the abdominal aorta above the renal arteries.
Aorta bi iliac femoral angiography with the catheter positioned of the aortic bifurcation
Selective left leg angiogram with the catheter presents in the left common femoral artery in the left popliteal artery
Intravascular ultrasound of the right popliteal artery and superficial femoral artery. Next Phoenix atherectomy of the left superficial femoral artery and popliteal artery using a 2.4 deflecting Phoenix
Balloon angioplasty of the left popliteal artery and anterior tibial artery using a 5 x 150 Jade balloon
Angio-Seal occlusion right common femoral artery
Conscious sedation administered by registered nurse 2 mg of Versed and 50 of fentanyl for a total of 55 minutes. Start time 6:45 a.m. end time 7:40 a.m..
TECHNIQUE/FINDINGS:
After informed consent was obtained, the patient was escorted to the procedure room. Both groins were prepped and draped in the appropriate sterile manner. Using ultrasound guidance, access was gained into the right common femoral artery in a retrograde fashion using a micro puncture needle. A permanent ultrasound image was obtained for the record. The artery was patent. She was into the right common femoral it was observed with the ultrasound. Copy saved for the record. We then placed a micro puncture sheath this was then upgraded to a 6 FR sheath. An omni flush catheter was then positioned just above therenal arteries. Next abdominal angiogram was done. The catheter was placed at the aortic bifurcation and bilateral oblique aorto biliofemoral arteriograms were performed. The catheter was then selectively advanced into the left common femoral artery and an arteriogram was performed. Once this was completed, the catheter was then repositioned Of the diagnostic angiogram and based on the patient's presentation we proceeded with intervention of the left leg. Patient was heparinized with 100 units heparin per kg of body we next placed a 7 x 45 cm sheath over the aortic bifurcation in the contralateral left common femoral artery. We next exchanged the 35 wire for a 14 wire. This 14 wire was was used to cross the severely diseased SFA and was advanced down into the anterior tibial artery. We then performed intervention over this 14 wire. The Left Superficial Femoral Artery was selectively catheterized and angiogram was performed. The arteriogram demonstrates moderate diffuse disease. The arteriogram demonstrates severe focal stenosis. Using an 0.014 wire and a support catheter, the diseased Left Superficial Femoral Artery was crossed. An angiogram was performed in the Left Superficial Femoral Artery confirming intraluminal location. The Left Superficial Femoral Artery was evaluated using intravascular ultrasound. The diameter of the Superficial Femoral Artery measured approximately 5 mm. There is 80 percent stenosis in the Superficial Femoral Artery. Using a Phoenix 2.4mm x 130cm , atherectomy was performed to the diseased portion of the Left Superficial Femoral Artery. The Left Superficial Femoral Artery was then dilated with a 5 mm balloon. Completion angiography revealed a focal area of dissection of the distal SFA where there was calcific diseased. Otherwise there were no distal embolization. No significant residual stenosis or perforation. In the area of the dissection the appeared to be small AV fistula. There were no extravasation. The sheath was removed. The puncture site was closed using an Angioseal closure device. Immediate hemostasis was achieved. No immediate complications.
FINDINGS:
Aorta: The right renal artery, left renal artery, superior mesenteric artery and the inferior mesenteric artery are all normal. The right common iliac artery, right external iliac artery, right internal iliac artery, left common iliac artery, left external iliac artery and left internal iliac artery are all normal.
Left Lower Extremity: The left common femoral artery is normal. The left proximal superficial femoral artery has 70 percent stenosis. The left mid superficial femoral artery has 70 percent stenosis. The left distal superficial femoral artery has 9 percent stenosis. The left profunda femoris is normal. The left proximal popliteal artery is normal. The left distal popliteal artery is normal. The left tibial peroneal trunk has 60 percent stenosis. The left proximal anterior tibial artery is normal. The left mid anterior tibial artery is normal. The left distal anterior tibial artery is normal. The left proximal posterior tibial artery has 60 percent stenosis. The left mid posterior tibial artery is normal. The left distal posterior tibial artery has 70 percent stenosis. The left proximal peroneal artery is normal. The left plantar arch is normal. The left dorsalis pedis artery is normal. The left distal peroneal artery is normal.
36200 (Unit: 1) ,36247 (Unit: 1) ,37225 (Unit: 1) ,37252 (Unit: 1) ,75630 (Unit: 1) ,75710 (Unit: 1) ,76937 (Unit: 1)
,99152 (Unit: 1) ,99153 (Unit: 4) ,G0269 (Unit: 1)
PROCEDURES
Ultrasound-guided access right common femoral artery.
Abdominal angiogram with the catheter was in the abdominal aorta above the renal arteries.
Aorta bi iliac femoral angiography with the catheter positioned of the aortic bifurcation
Selective left leg angiogram with the catheter presents in the left common femoral artery in the left popliteal artery
Intravascular ultrasound of the right popliteal artery and superficial femoral artery. Next Phoenix atherectomy of the left superficial femoral artery and popliteal artery using a 2.4 deflecting Phoenix
Balloon angioplasty of the left popliteal artery and anterior tibial artery using a 5 x 150 Jade balloon
Angio-Seal occlusion right common femoral artery
Conscious sedation administered by registered nurse 2 mg of Versed and 50 of fentanyl for a total of 55 minutes. Start time 6:45 a.m. end time 7:40 a.m..
TECHNIQUE/FINDINGS:
After informed consent was obtained, the patient was escorted to the procedure room. Both groins were prepped and draped in the appropriate sterile manner. Using ultrasound guidance, access was gained into the right common femoral artery in a retrograde fashion using a micro puncture needle. A permanent ultrasound image was obtained for the record. The artery was patent. She was into the right common femoral it was observed with the ultrasound. Copy saved for the record. We then placed a micro puncture sheath this was then upgraded to a 6 FR sheath. An omni flush catheter was then positioned just above therenal arteries. Next abdominal angiogram was done. The catheter was placed at the aortic bifurcation and bilateral oblique aorto biliofemoral arteriograms were performed. The catheter was then selectively advanced into the left common femoral artery and an arteriogram was performed. Once this was completed, the catheter was then repositioned Of the diagnostic angiogram and based on the patient's presentation we proceeded with intervention of the left leg. Patient was heparinized with 100 units heparin per kg of body we next placed a 7 x 45 cm sheath over the aortic bifurcation in the contralateral left common femoral artery. We next exchanged the 35 wire for a 14 wire. This 14 wire was was used to cross the severely diseased SFA and was advanced down into the anterior tibial artery. We then performed intervention over this 14 wire. The Left Superficial Femoral Artery was selectively catheterized and angiogram was performed. The arteriogram demonstrates moderate diffuse disease. The arteriogram demonstrates severe focal stenosis. Using an 0.014 wire and a support catheter, the diseased Left Superficial Femoral Artery was crossed. An angiogram was performed in the Left Superficial Femoral Artery confirming intraluminal location. The Left Superficial Femoral Artery was evaluated using intravascular ultrasound. The diameter of the Superficial Femoral Artery measured approximately 5 mm. There is 80 percent stenosis in the Superficial Femoral Artery. Using a Phoenix 2.4mm x 130cm , atherectomy was performed to the diseased portion of the Left Superficial Femoral Artery. The Left Superficial Femoral Artery was then dilated with a 5 mm balloon. Completion angiography revealed a focal area of dissection of the distal SFA where there was calcific diseased. Otherwise there were no distal embolization. No significant residual stenosis or perforation. In the area of the dissection the appeared to be small AV fistula. There were no extravasation. The sheath was removed. The puncture site was closed using an Angioseal closure device. Immediate hemostasis was achieved. No immediate complications.
FINDINGS:
Aorta: The right renal artery, left renal artery, superior mesenteric artery and the inferior mesenteric artery are all normal. The right common iliac artery, right external iliac artery, right internal iliac artery, left common iliac artery, left external iliac artery and left internal iliac artery are all normal.
Left Lower Extremity: The left common femoral artery is normal. The left proximal superficial femoral artery has 70 percent stenosis. The left mid superficial femoral artery has 70 percent stenosis. The left distal superficial femoral artery has 9 percent stenosis. The left profunda femoris is normal. The left proximal popliteal artery is normal. The left distal popliteal artery is normal. The left tibial peroneal trunk has 60 percent stenosis. The left proximal anterior tibial artery is normal. The left mid anterior tibial artery is normal. The left distal anterior tibial artery is normal. The left proximal posterior tibial artery has 60 percent stenosis. The left mid posterior tibial artery is normal. The left distal posterior tibial artery has 70 percent stenosis. The left proximal peroneal artery is normal. The left plantar arch is normal. The left dorsalis pedis artery is normal. The left distal peroneal artery is normal.
36200 (Unit: 1) ,36247 (Unit: 1) ,37225 (Unit: 1) ,37252 (Unit: 1) ,75630 (Unit: 1) ,75710 (Unit: 1) ,76937 (Unit: 1)
,99152 (Unit: 1) ,99153 (Unit: 4) ,G0269 (Unit: 1)