Hi,
Would someone be willing to look at this note and comment on the codes?
No prior diagnostic study done.
1. Ultrasound -guided access to left C.femoral w/ images stored into hard copy
2. Aortogram
3. Right lower extremity angiogram
4. Selective cannulation of third order vascular tree and selective angiogram of right lower extremity.
5. Angioplasty of posterior tibial artery and distal bypass graft at the level of the anastomosis.
Findings: High grade stenosis of the distal anastomosis site and a 2cm short obstruction in the native PT vessel approximately 2cm to the distal anastomosis site.
Ultra sound guidance access to the left common femoral artery was performed with images uploaded into a hard copy. The wire was advanced into the aorta under fluoroscopic guidance and a micropuncture sheath was inserted. A wire was positioned in the aorta followed by an ultra-flush catheter. An aortogram was performed, showing the distal portion of the aorta and the iliac vessels. There was no apparent lesion. Access was then gained into the right common femoral artery, using a glidewire and glide catheter technique, a right lower extremity angiogram was performed. There was sluggish flow through the bypass graft (femoral to posterior tibial bypass graft). Therefore, the wire and catheter was advanced into the bypass graft at the level of the knee and another angio of the right lower extremity was performed for better visualization. This showed a short focal stenosis at the anastomosis site and a focal occulsion just distal to the anastomsois. Based on these findings decision was made to intervene. A 6FR sheath was then inserted after placing a still Glidewire into the right lower extemity bypass graft. The patient was then given 8000 units of IV heparin. Using 014 system and as 018 glide catheter, the lesions were able to be traversed with manipulation and access was gained to the distal posterior tibial artery. The lesions were then marked and angipoplasty was performed using a 2.5mm x8cm balloon in 2 separate segements with pressure of 14 for 2 minutes at each location. At completion, the patient has less than 30% residual stenosis and good flow.
Would someone be willing to look at this note and comment on the codes?
No prior diagnostic study done.
1. Ultrasound -guided access to left C.femoral w/ images stored into hard copy
2. Aortogram
3. Right lower extremity angiogram
4. Selective cannulation of third order vascular tree and selective angiogram of right lower extremity.
5. Angioplasty of posterior tibial artery and distal bypass graft at the level of the anastomosis.
Findings: High grade stenosis of the distal anastomosis site and a 2cm short obstruction in the native PT vessel approximately 2cm to the distal anastomosis site.
Ultra sound guidance access to the left common femoral artery was performed with images uploaded into a hard copy. The wire was advanced into the aorta under fluoroscopic guidance and a micropuncture sheath was inserted. A wire was positioned in the aorta followed by an ultra-flush catheter. An aortogram was performed, showing the distal portion of the aorta and the iliac vessels. There was no apparent lesion. Access was then gained into the right common femoral artery, using a glidewire and glide catheter technique, a right lower extremity angiogram was performed. There was sluggish flow through the bypass graft (femoral to posterior tibial bypass graft). Therefore, the wire and catheter was advanced into the bypass graft at the level of the knee and another angio of the right lower extremity was performed for better visualization. This showed a short focal stenosis at the anastomosis site and a focal occulsion just distal to the anastomsois. Based on these findings decision was made to intervene. A 6FR sheath was then inserted after placing a still Glidewire into the right lower extemity bypass graft. The patient was then given 8000 units of IV heparin. Using 014 system and as 018 glide catheter, the lesions were able to be traversed with manipulation and access was gained to the distal posterior tibial artery. The lesions were then marked and angipoplasty was performed using a 2.5mm x8cm balloon in 2 separate segements with pressure of 14 for 2 minutes at each location. At completion, the patient has less than 30% residual stenosis and good flow.
